Substantially more health plans on the federal insurance marketplaces require consumers next year to pay a hefty portion of the cost of the most expensive drugs, changes that analysts say are intended to deter persistently ill patients from choosing their policies.
The class of medicines known as specialty drugs often treat chronic illnesses such as multiple sclerosis, rheumatoid arthritis, HIV, hemophilia, some cancers and hepatitis C. Individual doses can be priced at more than $600. Many newer medicines cost $5,000 to $10,000 a month. That means patients with even a small cost-sharing requirement have to come up with thousands of dollars. For many patients there are no cheaper and equally effective alternatives.
In the four years that the healthcare.gov marketplaces have existed, plans requiring consumers to pay roughly a third or more of the cost of specialty drugs have expanded to 63 percent of all offerings from 37 percent, according to a Kaiser Health News analysis.
High cost sharing is one reason that the marketplaces have been subject to criticism. The marketplaces, also called exchanges, may be phased out by a hostile Republican Congress and new president. Nonetheless, they remain important in 2017 — and possibly longer — for the millions of people who are buying insurance on or off the marketplaces.This KHN story also ran on Money. It can be republished for free (details).
Six of every seven policies in Maine, Missouri, New Jersey, Tennessee and Illinois, and every plan in Alaska, require consumers to pick up 30 percent or more of the cost of specialty drugs, the analysis found. Around the nation, some plans make consumers split the cost of these drugs with the insurer, and a few make consumers pick up the majority of the tab. In West Virginia, five Highmark Blue Cross Blue Shield plans require a $1,000 copayment for each specialty drug prescription.
As a practical matter, people relying on specialty drugs quickly run through their deductibles and maximum annual out-of-pocket costs, which next year will be no more than $7,150 for individuals. After that, the insurer must pick up the entire cost.
Researchers suspect some insurers are designing their plans with stingy specialty drug benefits to discourage patients who need them from signing up in the first place.
“Plans are no longer able to actively exclude people based on health status, but they still have an incentive to try to end up with healthier enrollees,” said Benjamin Sommers, a health economist at Harvard’s T.H. Chan School of Public Health. “This isn’t just about drugs. These drugs can be a signal of other types of high health care spending. The people who use them have conditions that make them more likely to end up in the hospital or emergency room.”
Ben Woodworth, a 28-year-old in Atlanta, said he pays $380 a month for medications that prevent his body from rejecting a transplanted kidney. The Blue Cross Blue Shield of Georgia policy he is considering for next year, which is not sold on the exchange, would require him to pay either 40 or 50 percent of the price of specialty drugs, depending on how the insurer classifies them.
“What seems so unreasonable about it was that for many years, on several different insurance plans, I paid no more than $20 a month” for the drugs, said Woodworth, who had previously been covered through a university at which he was studying or by his parents’ plan. “To have that suddenly turn into about $400 a month was hard.”
Even with high cost sharing, people using specialty drugs are less vulnerable financially than they were before the Affordable Care Act created the marketplaces. In addition to the limits on how much patients have to pay, insurers can no longer refuse to sell policies or charge more based on consumers’ health. The government also pays for much of the cost sharing for lower-income people in the marketplaces, although this, too, is on the chopping block of a Republican Congress.Specialty Cost Sharing
The majority of Insurance plans being sold on the health marketplaces require consumers to pick up a large share of the cost of specialty drugs.
This chart shows the percent of plans in each state that require consumers to pay for 30 percent or more of the cost of those drugs.
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Rising Costs ‘Unstainable’
The insurance industry and President Barack Obama’s administration say benefit changes are a reaction to the increasing cost and use of the medicines, especially unique ones where drug makers can dictate prices. Express Scripts, a pharmacy manager, estimated 576,000 people took more than $50,000 worth of medications during 2014.
“Rising prescription drug costs are an issue throughout the health care system, especially specialty drugs,” said Aaron Albright, a spokesman for the Department of Health and Human Services.
Kristine Grow, a spokeswoman for the trade group America’s Health Insurance Plans, denied that insurers are raising cost sharing to avoid expensive patients. “The true issue here is that the ever-increasing costs of specialty drugs are simply unsustainable,” she said.
But Caroline Pearson, an executive at the health consulting firm Avalere, said insurers have an incentive to repel patients in poor health because of flaws in the government’s method of reimbursing them if they get an unexpectedly large share of very ill customers.
“The model doesn’t adjust for the severity of your disease,” she said. For instance, she added, the government recognizes that a rheumatoid arthritis diagnosis means a patient is sicker than many others, but people with severe cases and mild ones are considered to be equal in health. People who use specialty drugs are more often suffering from acute ailments than are those who use other types of medicines, she said.
“It’s effectively a race to the bottom,” Pearson said. “You don’t want to be the single plan in a region with really good coverage for high-cost conditions.”
The government is proposing tweaks to its models that would do a better job of assessing patient health, but that would not take effect next year.
Other Costs Up, Too
Consumers are not just being squeezed by their share of the rise in specialty drug costs. High cost-sharing requirements for brand-name drugs that are not on insurers’ preferred lists have increased at a similar rate as for specialty drugs, KHN’s analysis found.
Some insurers are making high cost sharing for specialty drugs — 30 percent or more — a component of the majority of their plans. KHN’s analysis found that 85 percent of BlueCross BlueShield of Illinois and Florida Blue have that level of cost sharing. Of 373 plans offered by Anthem subsidiaries that KHN examined, 81 percent require consumers to pay 40 percent or more of the cost of specialty drugs.
Greg Thompson, a spokesman for Health Care Service Corp., which owns BlueCross BlueShield of Illinois, said in an email that its high cost sharing for specialty drugs allows it to pick up more of the cost of generic and brand-name drugs “and allows us to design plans that have a broader appeal across the entire marketplace.” But KHN’s analysis found insurers are also increasing patients’ contributions for the cost of the brand name drugs that are on those lists. In 2014, 38 percent of plans charging copays made customers pay $50 or more per prescription. By 2017 that portion had risen to 67 percent.
Robert Zirkelbach, a spokesman for the drug industry trade group PhRMA, said insurers had “powerful tools” to negotiate lower prices for medicines with drug companies, including the threat of not covering them at all. “At the end of the day, for any particular medicine, they make a determination of whether they are going to cover it and what formulary it’s going to sit on,” he said.
Paul Kluding, a spokesman for Florida Blue, said in an email that many drug makers offer coupons that can reduce some of the cost that consumers pay out of pocket for the drugs. That does not cut the insurers’ costs, however.
In September, the Center for Health Law and Policy Innovation at Harvard’s law school filed civil rights complaints with the federal government charging that insurers in eight states are using high cost sharing and other methods to discriminate against people with HIV or other chronic conditions.
Jane Parker, who runs a small business with her husband in Naples, Fla., expects to pay $15,643 in premiums and out-of-pocket costs next year. The monthly infusion she receives of Orencia, which treats her rheumatoid arthritis, costs $11,000 a month, including the hospital charges for the procedure.
Parker, 57, said she expects she will have to pay her new plan’s out-of-pocket maximum of $6,350 in January, but it is unavoidable since no other medication has worked for her.
Without the infusions, she said, “I wouldn’t be walking.”
KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.
SAN FERNANDO, Calif., — It’s early on a Wednesday morning and this city’s Recreation Park is bustling with dozens of people doing sprints, leg lifts and squats as enthusiastic students from California State University, Northridge cheer them on.
“Everyone excited?” 19-year-old Celeste Alcala asked as her group lifted exercise balls.
“Yes!” the men and women responded in unison.
The Cal State students are instructors in a free exercise program offered at parks in the San Fernando Valley, South Los Angeles, San Francisco and Stanislaus County. The participants are mostly Latino, and many had never exercised regularly before joining the group. Several have diabetes, high blood pressure or other chronic diseases.
Irma Fuentes, 53, attends the exercise boot camp three times each week. She said it has motivated her to change her diet, lose weight and start hiking with her husband on the weekends. Fuentes said her blood pressure is under control, “and I have a lot of energy now.”Use Our Content This story can be republished for free (details).
The program, 3WINS Fitness, started at Recreation Park in 2011 before expanding to several other sites. Cal State Northridge Professor Steven Loy, who founded the program, said he and his students are working to bring the program to parks throughout California. Their goal is to partner with other Cal State campuses and train their students to run the programs in their cities.
Loy said 3WINS got its name from the idea that it is positive for students, participants and the community.
The program, he said, helps people get moving — and meet the federally recommended exercise requirements — without having to pay for expensive fitness club memberships. The federal government recommends that adults get at least 150 minutes of moderate aerobic activity each week and do muscle strengthening exercises at least two days during the week.
“We are trying to make it as easy as possible,” said Loy, who teaches kinesiology and exercise physiology. “It provides an avenue for people to exercise who either can’t afford it or aren’t comfortable in a traditional gym setting.”
That’s what attracted Maria Barajas to the classes. Exercising at the park is “way better than the gym,” the 59-year-old said. She likes the students’ energy and has developed friendships with her exercise partners. “This is like my other family,” she said.
Free park-based programs like 3WINS help increase physical activity among low-income residents and can prevent or lessen the impact of chronic diseases, according to Deborah Cohen, senior scientist at the RAND Corporation who conducted an evaluation of the program in 2015.
“One of the most potent medicines is regular physical activity,” Cohen said.
She found that programs like Cal State’s give people the motivation to use parks for exercise, and that such collaborations could be a model for other communities trying to increase the physical activity of their residents and reduce chronic diseases. While other parks around the nation offer recreation or exercise classes, they aren’t typically free. Overall, Cohen said, parks are underutilized, especially in low-income areas. And park-based programs that do exist generally target youth rather than adults and seniors, according to another study by Cohen.
The Cal State program, which was recognized by Michelle Obama’s Let’s Move campaign, is unique because of the partnership between parks and state universities, Cohen said.
At Recreation Park, participants also can have their blood pressure checked and participate in student-run diabetes prevention and management classes.
Students can receive academic credit for volunteering, which Loy said gives the program built-in sustainability and eliminates the need for outside funding. The students not only apply what they are learning in class but they also gain business and leadership skills.
One of the volunteers, 24-year-old Aidee Corona, said she was interested in the program because her mom and grandma both have diabetes and she wanted to see how exercise could help people change their lifestyles.
Corona said that since she started volunteering about two years ago, she has learned more about how to communicate with people and “how to motivate them to keep exercising.” She graduated in the spring and said she is planning to become a physical therapist.
Celeste Alcala, who is in her second year at Cal State Northridge, said she was a little intimidated at first but soon became more comfortable leading the groups. “I have definitely grown a lot as a person,” she said. “It’s a good learning experience.”
Alcala said she is glad to be able to use what she is learning in kinesiology classes, including how different exercises work different parts of the body. “It is a lot different when you read something and when you see it in person,” she said.
Before the San Fernando program started, Recreation Park was frequently empty, said Ismael Aguila, the city’s director of recreation and community services. The city rarely could get enough people to participate in a low-cost exercise class. People also regularly took naps in the park, he said.
“The parks here in the city were suffering significantly,” Aguila said. “They were really underutilized.”
The free boot camp run by the students attracted people to the park and gave the city momentum to get more involved in public health efforts, Aguila said. Now, he said, San Fernando is offering additional classes, which provide revenue that helps pay for equipment used by the 3WINS volunteers.
Cohen said all parks should have exercise programs to help increase physical activity around the nation. “That would promote health and wellbeing and it could reduce health care costs,” she said.
As rates of prescription painkiller abuse remain stubbornly high, a number of states are attempting to cut off the supply at its source by making it harder for doctors to prescribe the addictive pills to Medicaid patients.
Recommendations on how to make these restrictions and requirements were detailed in a “best practices” guide from the federal Centers for Medicare and Medicaid Services.
But the move is prompting worry from some physicians who say it could have the unintended consequence of keeping appropriate medical treatment from people with chronic pain.
The CMS protocols, released last January, encourage but do not demand that state Medicaid programs adopt more stringent coverage requirements for opioids, such as requiring physicians to get prior authorization before writing a prescription or stipulating that patients try other treatment options first, which is sometimes called “step therapy.” Patients may also have to provide proof that they meet certain medical criteria in order for their pain pills to be covered.This KHN story also ran in Stat. It can be republished for free (details).
Some states’ efforts to curtail prescribing predated CMS’ bulletin. But the advisory added new fuel to the trend. States such as New York, Rhode Island and Maine adopted new prescription size limits this year, and West Virginia will require prior authorization starting next year. In the 2016 fiscal year, 22 states either adopted or toughened their prescription size limits, and 18 did so with prior authorization.
The goal is to make physicians think twice before prescribing the highly addictive medicines — a change many say is necessary, especially within the state-federal health insurance program for low-income people. After all, research indicates Medicaid beneficiaries are prescribed opioids at twice the rate of the rest of the population, and are at three to six times greater risk of an overdose.
They can take the form of seemingly straightforward controls such as limiting prescriptions to a one-month supply and requiring patients to pick up the doctors’ written refill order in person. For some, though, they are problematic.
“This is really going to limit patient access,” said John Meigs, president of the American Academy of Family Physicians, and a practicing doctor in Centreville, Ala. “There are patients with legitimate pain, who have legitimate need.”
So far, state policies increasingly echo the CMS suggestions. Forty-six Medicaid programs have put in place prescription caps, 45 require prior authorization, 42 need proof of meeting clinical guidelines and 32 allow the drugs only after patients have exhausted other options.
Some commercial plans are also using these kinds of strategies, though experts said it’s unclear how far that trend will spread.
“This is an indication that policymakers are finally recognizing that overprescribing of opioids is fueling the epidemic,” said Dr. Andrew Kolodny, a Brandeis University senior scientist and the executive director of Physicians Responsible for Opioid Prescribing, an advocacy group.
But others note this perspective overlooks the separate, underlying challenge of treating a chronic condition. “Just because it is now harder to prescribe patients opioid medicines, it does not mean we have fewer patients who have pain,” said Dr. Eric Weil, the associate chief for clinical affairs in internal general medicine at Massachusetts General Hospital in Boston.
Such restrictions can become a difficulty, especially since Medicaid beneficiaries already are dealing with limited means.
For instance, a smaller prescription dose means patients — whose chronic pain makes making travel a hardship — have to visit the doctor more often for medicine. Not only is that difficult, it can absorb time and extra transportation money.
That kind of experience is leading some state Medicaid officials to seek a balance between limiting abuse and allowing reasonable access to medications.
Louisiana’s Medicaid program, for instance, already has capped the number of pills a doctor can prescribe, so a prescription can’t span longer than 30 days, and requires proof that clinical guidelines have been followed before opioid painkillers are used. State officials are eyeing additional changes, such as lower prescription caps and potentially requiring prior authorization for opioid prescriptions.
But there can be a tension between these limits and coverage of other pain management options. For example, beneficiaries are limited to one visit with a pain specialist. They also can receive prescriptions for some less powerful and usually less effective pain medications.
“It’s not enough,” said Dr. SreyRam Kuy, Louisiana’s Medicaid medical director. And years of budget cuts to the program mean it’s difficult to pony up the funds to properly cover a robust array of care options.
“We need much more to address this,” she said. “If you just cut off the pills, it’s not addressing the bigger picture.”
Massachusetts also has in place some of the prescribing controls. But it, too, is “pretty haphazard” when it comes to making alternatives available, Weil said.
That’s a real concern, said Dr. Steve Diaz, an emergency physician in Maine, who is consulting with that state’s Medicaid program as it develops its regulations. The patients being squeezed often don’t have extra money to pay out of pocket for things such as acupuncture, tai chi or yoga class, all of which can sometimes be used to help manage pain, he noted.
That said, given the spread of opioid abuse, using insurance rules to curtail prescribing makes sense, he said. And while evidence is limited, restricting coverage has worked to drive down prescriptions of other particular drugs.
But “these are blunt instruments,” he said. “We do have to be thoughtful.”
That’s why some are trying other tacks. At Massachusetts General, Weil said, the hospital’s teaching doctors about other approaches, but also providing regular feedback and tracking how often physicians prescribe opioids. The idea, he said, is to go beyond education, which “tends to last a good 90 days, and then people forget.” By building in feedback loops and reminders the hospital hopes to drive a deeper culture shift and have more meaningful impact.
Meanwhile, if Medicaid plans try to curb physician painkiller prescribing, they need to be nuanced, Kuy said. For instance, states must account for people such as cancer patients, who may legitimately need heavy-duty painkillers. Carving out the right kinds of exceptions, Diaz said, will be a major challenge.
And, experts noted, it’s still unclear if these strategies can make a difference.
“Will these policies have the intended effects? There’s very limited evidence [they will],” said Dr. Jonathan Chen, an instructor at Stanford University School of Medicine, who has researched opioid abuse. “On the other hand, the problem has grown to the point where we have to do something.”
On Tuesday, President-elect Donald Trump tapped Seema Verma, a health care consultant, to head the Centers for Medicare and Medicaid Services. That’s the part of the Department of Health and Human Services that oversees Medicare, Medicaid, and the Children’s Health Insurance Program and has a budget of just under a trillion dollars in 2016.
Verma comes to the job with extensive Medicaid experience. Her consulting firm, SVC, Inc., worked closely with Indiana Gov. Mike Pence to design Indiana’s Medicaid expansion under the Affordable Care Act. The expansion, known as the Healthy Indiana Plan or HIP 2.0, went into effect early last year, and Verma’s involvement may be important as Congress and the Trump administration, including the vice-president elect, make decisions on the future of the ACA.
Indiana’s unique Medicaid expansion was designed to appeal to conservatives. HIP 2.0 asks covered people to make a small monthly payment to access health insurance. A missed payment can result in six-month lockout from insurance coverage. Those provisions aren’t allowed under traditional Medicaid, but Indiana got special permission from CMS to implement them through a waiver.
Other Republican-led states such as Iowa, Ohio and Kentucky, have contracted with Verma’s firm to help submit their own Medicaid expansion proposals to the federal government that also include conservative provisions such as asking recipients to pay for some of their care, or requiring them to work or be actively looking for work.This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News. It can be republished for free. (details)
Susan Jo Thomas, who heads the Indiana insurance advocacy group Covering Kids and Families, said Verma’s contributions to HIP 2.0 made Medicaid expansion possible in a Republican state. “She understood that in order to get expansion in this state,” she said. “It’s more about what is palatable, what can get approved.”
Nearly 410,000 people are members of HIP 2.0, according to the latest data from the state.
But HIP 2.0 has its critics. David Machledt, a policy analyst with the National Health Law Program, which advocates for health care for low-income individuals, argued that the cost-sharing provisions or if a person is temporarily removed from Medicaid actually reduce participation in the program. “Early evaluations show that a lot of people don’t understand this plan and don’t understand the incentives in it,” he said. That means people end up not getting the health care they need.
Nevertheless, Machledt said if Medicaid expansion continues, Verma’s pick to head CMS could mean that proposals similar to Indiana’s may be more likely to be approved.
Joan Alker with the Georgetown Center for Children and Families agrees, and finds it worrisome. “It is a good thing that she has experience with Medicaid and it is a positive that Governor Pence worked with Ms. Verma to advance a version of Medicaid expansion,” she said. “But I think if you look at the totality of the Trump administration’s picks today—Congressman Price as well as Ms. Verma—this represents potentially a very damaging and chaotic restructuring of the Medicaid program.” Price has advocated severely cutting Medicaid funding, and Alker worries that cuts and more stringent requirements under Verma mean people will lose the health insurance.
“The Healthy Indiana Plan has occurred in the context of generous federal funding,” she said. “And I think some of that is on deck to go away.”
But Verma may be a smart pick, said Indiana Rep. Charlie Brown, the ranking Democrat in the state’s public health committee. “She is a smooth operator, and very, very persuasive,” he said. Brown worked in opposition to Verma in crafting the Healthy Indiana Plan, but said she worked effectively across party lines to incorporate the Pence administration’s wishes into the program.
“She’s very resourceful and intelligent,” said Brown. “But the question now becomes, ‘What will be her marching orders as they relate to Medicare and Medicaid?’ ”
Verma’s role in shaping Indiana’s health care policy has had some controversy. According to a 2014 report from The Indianapolis Star, she has received millions of dollars from the state through her work with the Indiana government. She was also paid by Hewlett-Packard, a Medicaid vendor that received more than $500 million in state contracts. Government ethics experts told the Star the arrangement presented a conflict of interest.
Verma did not immediately respond to requests for comment, nor did Gov. Pence’s office.
President-elect Donald Trump’s selection of Rep. Tom Price to head the Department of Health and Human Services signals that the new administration is all-in on both efforts to repeal the Affordable Care Act and restructure Medicare and Medicaid.
Price, a Georgia Republican who currently chairs the House Budget Committee, was among the first to suggest that not just the ACA but also Medicare are on the near-term agenda for newly empowered Republicans.
Privatizing the Medicare program for seniors and disabled people and turning the Medicaid program for the poor back to the states are long-time goals for Republicans in Congress and the White House. They say the moves could help put the brakes on health spending. Opponents argue, however, that both changes are aimed instead at shifting the financial burden of health care from the federal budget to states and individuals.
That question — should the federal government continue to provide open-ended health benefits? — could prove to be a key battle line.
Democrats and consumer advocates say the changes would break a promise to guarantee health services made when Medicare and Medicaid were enacted in 1965.
“That is the explicit intent of these proposals, to cap liability and shift costs,” said Edwin Park of the left-leaning think tank the Center on Budget and Policy Priorities.
Len Nichols of George Mason University agreed: “It’s about fixing the growth rate so they can be certain of a lower federal commitment to health care.”
Republicans, however, say in the face of rising federal deficits, it would be irresponsible not to rein in the programs’ spending.
“We have a moral obligation to the country to do this,” House Speaker Paul Ryan told the New York Times in 2011, when he first proposed the plans as chairman of the House Budget Committee.
Medicare, which covers roughly 57 million elderly and disabled Americans, and Medicaid, which covers more than 77 million people with low incomes, are among the biggest items in the federal budget, together costing an estimated $1 trillion in 2016, according to the Congressional Budget Office.
And, more importantly, both programs are expected to keep growing, consuming ever more of the budget. According to the CBO, over the next 30 years, the percentage of federal spending claimed by the major federal health programs (primarily Medicare and Medicaid) is expected to rise from just over 6 percent to more than 10 percent.
“By reforming these programs in the future, we can preserve them for the present,” said Ryan in another 2011 interview.
Both GOP proposals for the major medical entitlement programs date back decades.
Proposals to replace the open-ended Medicaid program, in which the federal government matches whatever states spend, with a block grant that would limit the federal government’s financial responsibility first surfaced in the early 1980s, during the Reagan administration. When Republicans took over Congress in 1994, the idea reemerged, was passed and sent to President Bill Clinton, who vetoed it. President George W. Bush revived the idea again in 2003, but he could not get Congress to act on it.
The latest version of the proposal offered by House Republicans would give states the option of modifying the plan so that the federal payments to states would be based on a per capita funding formula.
A number of Republican governors have supported the idea, because the program would generally relieve states from rules governing who and what to cover in Medicaid in exchange for accepting limited funding.
But advocates for the poor say it would lead to fewer people getting fewer services. Because the federal contribution proposed by Ryan is specifically set to increase more slowly than predicted inflation in health care, “states could either contribute much more to their Medicaid programs, or, more likely, use that flexibility to make deep cuts to the program,” said Park.
A 2012 estimate from the Urban Institute said that year’s proposal could result in 17 million people losing coverage, and payments to health care providers could be cut by nearly a third.
Thomas Miller of the conservative American Enterprise Institute says more recent proposals have gotten less draconian. “It’s gotten a little better because as opposed to a big block grant, it’s gone to the per capita allotments” that would be based on the number of people enrolled in the program.
Park of the CBPP said that would be better than simply giving states a single pot of money. With a per-capita cap, the federal contribution would rise as more people are added to the program. But the cuts would still be deep, he said, because “you’re achieving similar savings by slashing spending per beneficiary.”
In Medicare, the concept of “premium support,” which would give enrollees a set amount of money to spend on the health plan of their choice, emerged in the mid-1990s. The original proposal was geared to using competition to slow the growth of Medicare spending.
But later iterations of the Medicare proposal would increase contributions intended to pay for insurance more slowly than the expected rate of health inflation. That means that instead of covering the government’s share of a set package of benefits, what is currently referred to as Medicare’s defined benefit, the program would instead pay a specific amount, often referred to as a defined contribution, that might not be able to pay for those benefits.
“Right now, the federal government says you pay [a set share] of those costs” through Medicare premiums, deductibles and co-pays and beneficiaries get government funding to cover guaranteed benefits in return, said Park. “Under premium support there would no longer be that guarantee and there would no longer be a defined set of benefits.”
Miller of AEI said any effort to push these GOP plans for Medicare and Medicaid will run into stiff headwinds — even in a Republican-controlled Congress — because it’s difficult to take something away from people.
Congress can’t simply cut the programs, he said. “You have to tell people why you’re doing this. You have to say this is actually going to improve the health care system.”
On Tuesday, December 6, the Law Library of Congress and the Center for the Book will host a book talk featuring Michael Signer. He will discuss his book, Becoming Madison: The Extraordinary Origins of the Least Likely Founding Father (Public Affairs, 2015), which focuses on U.S. President James Madison’s life before age 36. After the discussion, Dr. Signer will be available to sign copies of his book.
Michael Signer is lecturer at the Batten School of Public Policy and Leadership at the University of Virginia, managing principal of Madison Law & Strategy Group, PLLC, and the Mayor of Charlottesville, Virginia. He holds a Ph.D. in political science from U.C., Berkeley, where he was a National Science Foundation Graduate Research Fellow; a J.D. from the University of Virginia School of Law; and a B.A. in politics from Princeton University. He was counsel to then-Governor Mark Warner of Virginia; National Security Director of the 2008 John Edwards for President Campaign; Senior Policy Advisor at the Center for American Progress; and a candidate for Lieutenant Governor of Virginia in 2009.
Dr. Signer is also the author of Demagogue: The Fight to Save Democracy from Its Worst Enemies. His writings have been published in The Atlantic, The Washington Post, The New Republic, Democracy, The Richmond Times-Dispatch, and USA Today, and he has appeared on MSNBC, Fox News, the BBC, and NPR.
We hope you can join us for this event!