Judge orders federal health websites restored
The big picture: District Court Judge John Bates granted a request from Doctors for America for a temporary restraining order, saying the physicians' group showed "substantial likelihood of success" on its claims that Health and Human Services, the Centers for Disease Control and Prevention and the Food and Drug Administration acted arbitrarily and capriciously in removing the webpages.
The group said the removed content helps guide practitioners, is essential to public health research and is key to preventing disease outbreaks.
Catch up quick: Thousands of webpages containing federal health guidelines and data went dark late last month. Some soon reappeared without clarity on what had been changed or removed — and with disclaimers noting that the pages could be further modified.
Among the affected sites was CDC's website for the Advisory Committee on Immunization Practices, which hosts vaccine recommendations for kids and adults.
Websites tracking issues including HIV prevention and transgender care were also taken down.
The CDC said that all changes to HHS websites were in accordance with executive orders calling for an end to federal diversity, equity and inclusion programs and declaring the government will only recognize two sexes, male and female.
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Hamilton Spectator
2 hours ago
- Hamilton Spectator
As the ADA turns 35, groups fighting for disability rights could see their federal dollars slashed
TOPEKA, Kan. (AP) — Nancy Jensen believes she'd still be living in an abusive group home if it wasn't shut down in 2004 with the help of the Disability Rights Center of Kansas, which for decades has received federal money to look out for Americans with disabilities. But the flow of funding under the Trump administration is now in question, disability rights groups nationwide say, dampening their mood as Saturday marks the 35th anniversary of the landmark Americans with Disabilities Act. Federal dollars pay for much of their work, including helping people who seek government-funded services and lawsuits now pushing Iowa and Texas toward better community services. Documents outlining President Donald Trump's budget proposals show they would zero out funds earmarked for three grants to disability rights centers and slash funding for a fourth. Congress' first discussion of them, by the Senate Appropriations Committee, is set for Thursday, but the centers fear losing more than 60% of their federal dollars. The threat of cuts comes as the groups expect more demand for help after Republicans' tax and budget law complicated Medicaid health coverage with a new work-reporting requirement. There's also the sting of the timing: this year is the 50th anniversary of another federal law that created the network of state groups to protect people with disabilities, and Trump's proposals represent the largest potential cuts in that half-century, advocates said. The groups are authorized to make unannounced visits to group homes and interview residents alone. 'You're going to have lots of people with disabilities lost,' said Jensen, now president of Colorado's advisory council for federal funding of efforts to protect people with mental illnesses. She worries people with disabilities will have 'no backstop' for fighting housing discrimination or seeking services at school or accommodations at work. The potential budget savings are a shaving of copper from each federal tax penny. The groups receive not quite $180 million a year — versus $1.8 trillion in discretionary spending. Trump's administration touts flexibility for sta tes The president's Office of Management and Budget didn't respond to an email seeking a response to the disability rights groups' criticism. But in budget documents, the administration argued its proposals would give states needed flexibility. The U.S. Department of Education said earmarking funds for disability rights centers created an unnecessary administrative burden for states. Trump's top budget adviser, Russell Vought, told senators in a letter that a review of 2025 spending showed too much went to 'niche' groups outside government. 'We also considered, for each program, whether the governmental service provided could be provided better by State or local governments (if provided at all),' Vought wrote. Disability rights advocates doubt that state protection and advocacy groups — known as P&As — would see any dollar not specifically earmarked for them. They sue states, so the advocates don't want states deciding whether their work gets funded. The 1975 federal law setting up P&As declared them independent of the states, and newer laws reinforced that. 'We do need an independent system that can hold them and other wrongdoers accountable,' said Rocky Nichols, the Kansas center's executive director. Helping people with disabilities navigate Medicaid Nichols' center has helped Matthew Hull for years with getting the state to cover services, and Hull hopes to find a job. He uses a wheelchair; a Medicaid-provided nurse helps him run errands. 'I need to be able to do that so I can keep my strength up,' he said, adding that activity preserves his health. Medicaid applicants often had a difficult time working through its rules even before the tax and budget law's recent changes, said Sean Jackson, Disability Rights Texas' executive director. With fewer dollars, he said, 'As cases are coming into us, we're going to have to take less cases.' The Texas group receives money from a legal aid foundation and other sources, but federal funds still are 68% of its dollars. The Kansas center and Disability Rights Iowa rely entirely on federal funds. 'For the majority it would probably be 85% or higher,' said Marlene Sallo, executive director of the National Disability Rights Network, which represents P&As. The Trump administration's proposals suggest it wants to shut down P&As, said Steven Schwartz, who founded the Center for Public Representation, a Massachusetts-based organization that works with them on lawsuits. Investigating allegations of abuse and pushing states Federal funding meant a call in 2009 to Disability Rights Iowa launched an immediate investigation of a program employing men with developmental disabilities in a turkey processing plant. Authorities said they lived in a dangerous, bug-infested bunkhouse and were financially exploited. Without the dollars, executive director Catherine Johnson said, 'That's maybe not something we could have done.' The Kansas center's private interview in 2004 with one of Jensen's fellow residents eventually led to long federal prison sentences for the couple operating the Kaufman House, a home for people with mental illnesses about 25 miles (40 kilometers) north of Wichita. And it wasn't until Disability Rights Iowa filed a federal lawsuit in 2023 that the state agreed to draft a plan to provide community services for children with severe mental and behavioral needs. For 15 years, Schwartz's group and Disability Rights Texas have pursued a federal lawsuit alleging Texas warehouses several thousand people with intellectual and developmental disabilities in nursing homes without adequate services. Texas put at least three men in homes after they'd worked in the Iowa turkey plant. Last month, a federal judge ordered work to start on a plan to end the 'severe and ongoing' problems. Schwartz said Disability Rights Texas did interviews and gathered documents crucial to the case. 'There are no better eyes or ears,' he said. ___ Hunter reported from Atlanta.
Los Angeles Times
7 hours ago
- Los Angeles Times
Trump voters wanted relief from Medical bills. For millions, the bills are about to get bigger
President Trump rode to reelection last fall on voter concerns about prices. But as his administration pares back federal rules and programs designed to protect patients from the high cost of health care, Trump risks pushing more Americans into debt, further straining family budgets already stressed by medical bills. Millions of people are expected to lose health insurance in the coming years as a result of the tax cut legislation Trump signed this month, leaving them with fewer protections from large bills if they get sick or suffer an accident. At the same time, significant increases in health plan premiums on state insurance marketplaces next year will likely push more Americans to either drop coverage or switch to higher-deductible plans that will require them to pay more out-of-pocket before their insurance kicks in. Smaller changes to federal rules are poised to bump up patients' bills, as well. New federal guidelines for COVID -19 vaccines, for example, will allow health insurers to stop covering the shots for millions, so if patients want the protection, some may have to pay out-of-pocket. The new tax cut legislation will also raise the cost of certain doctor visits, requiring copays of up to $35 for some Medicaid enrollees. And for those who do end up in debt, there will be fewer protections. This month, the Trump administration secured permission from a federal court to roll back regulations that would have removed medical debt from consumer credit reports. That puts Americans who cannot pay their medical bills at risk of lower credit scores, hindering their ability to get a loan or forcing them to pay higher interest rates. 'For tens of millions of Americans, balancing the budget is like walking a tightrope,' said Chi Chi Wu, a staff attorney at the National Consumer Law Center. 'The Trump administration is just throwing them off.' White House spokesperson Kush Desai did not respond to questions about how the administration's health care policies will affect Americans' medical bills. The president and his Republican congressional allies have brushed off the health care cuts, including hundreds of billions of dollars in Medicaid retrenchment in the mammoth tax law. 'You won't even notice it,' Trump said at the White House after the bill signing July 4. 'Just waste, fraud, and abuse.' But consumer and patient advocates around the country warn that the erosion of federal health care protections since Trump took office in January threatens to significantly undermine Americans' financial security. 'These changes will hit our communities hard,' said Arika Sánchez, who oversees health care policy at the nonprofit New Mexico Center on Law and Poverty. Sánchez predicted many more people the center works with will end up with medical debt. 'When families get stuck with medical debt, it hurts their credit scores, makes it harder to get a car, a home, or even a job,' she said. 'Medical debt wrecks people's lives.' For Americans with serious illnesses such as cancer, weakened federal protections from medical debt pose yet one more risk, said Elizabeth Darnall, senior director of federal advocacy at the American Cancer Society's Cancer Action Network. 'People will not seek out the treatment they need,' she said. Trump promised a rosier future while campaigning last year, pledging to 'make America affordable again' and 'expand access to new Affordable Healthcare.' Polls suggest voters were looking for relief. About 6 in 10 adults — Democrats and Republicans — say they are worried about being able to afford health care, according to one recent survey, outpacing concerns about the cost of food or housing. And medical debt remains a widespread problem: As many as 100 million adults in the U.S. are burdened by some kind of health care debt. Despite this, key tools that have helped prevent even more Americans from sinking into debt are now on the chopping block. Medicaid and other government health insurance programs, in particular, have proved to be a powerful economic backstop for low-income patients and their families, said Kyle Caswell, an economist at the Urban Institute, a think tank in Washington, D.C. Caswell and other researchers found, for example, that Medicaid expansion made possible by the 2010 Affordable Care Act led to measurable declines in medical debt and improvements in consumers' credit scores in states that implemented the expansion. 'We've seen that these programs have a meaningful impact on people's financial well-being,' Caswell said. Trump's tax law — which will slash more than $1 trillion in federal health spending over the next decade, mostly through Medicaid cuts — is expected to leave 10 million more people without health coverage by 2034, according to the latest estimates from the nonpartisan Congressional Budget Office. The tax cuts, which primarily benefit wealthy Americans, will add $3.4 trillion to U.S. deficits over a decade, the office calculated. The number of uninsured could spike further if Trump and his congressional allies don't renew additional federal subsidies for low- and moderate-income Americans who buy health coverage on state insurance marketplaces. This aid — enacted under former President Joe Biden — lowers insurance premiums and reduces medical bills enrollees face when they go to the doctor or the hospital. But unless congressional Republicans act, those subsidies will expire later this year, leaving many with bigger bills. Federal debt regulations developed by the Consumer Financial Protection Bureau under the Biden administration would have protected these people and others if they couldn't pay their medical bills. The agency issued rules in January that would have removed medical debts from consumer credit reports. That would have helped an estimated 15 million people. But the Trump administration chose not to defend the new regulations when they were challenged in court by debt collectors and the credit bureaus, who argued the federal agency had exceeded its authority in issuing the rules. A federal judge in Texas appointed by Trump ruled that the regulation should be scrapped. Levey writes for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism.
Business Journals
7 hours ago
- Business Journals
Waiting for pharmacy benefit manager reform from Washington? Here's what to do now.
If you're frustrated with your pharmacy benefit manager (PBM), join the club. A recent survey found that three-fifths of large-company benefit leaders said their PBM contracts were opaque, overly complicated, and contained clauses that profit the PBM at the expense of employers and patients. Thankfully, you're not stuck. Washington is working on PBM reform, one of the rare issues for which there is agreement between both parties in Congress and the Trump administration. Of course, consensus isn't always enough to create legislation, and any passed law will take time to come into force. A recently-enacted bill in Colorado addresses some of these issues, but will not apply to many large employer-sponsored plans. What follows is a guide to the problems with PBM contracts, the reform proposals, and two approaches to addressing the existing issues that don't require waiting on Washington: Finding a new generation of PBM committed to more transparency; and Negotiating a more transparent arrangement with your current PBM. The problem with large PBMs Pharmacy benefit managers were created to reduce employer costs, yet over time they have evolved in ways that often incentivize increases in plan sponsor and employee costs: Vertical Integration: Nearly 80% of the prescription market (which totaled $600 billion in 2023) is controlled by PBMs run by the three largest health insurance carriers: CVS Caremark (owns Aetna), OptumRX (owned by UnitedHealth Group), and Express Scripts (owned by Cigna). Spread pricing: PBMs charge employers more than they pay pharmacies for drugs, keeping the difference. Drug company rebates: These payments are often in return for PBMs steering business to their products and can include other undisclosed fees. Misaligned Incentives: By favoring their own specialty and mail-order (or retail) pharmacies, PBMs may be restricting competition and limiting their interest in negotiating the lowest pharmacy markups. A recent FTC study found that PBMs often charged employers a markup for specialty drugs distributed through their affiliated pharmacies of more than 100% — and sometimes more than 1,000%. Recently, the big PBMs have started joint ventures to manufacture their own generic and biosimilar drugs, creating another potential conflict. Secrecy: PBM common practices such as spread pricing, rebates, contractual gag clauses, price list manipulation and others have created an environment ripe with opaqueness and confusion for employers. The proposed legislation Congress has been looking closely at PBM reform for several years, and a detailed bipartisan bill was removed from last December's stop-gap budget after Elon Musk tweeted that it was too long. Leading committees are now working to pass something similar. Indeed, two bills that passed Committee last year were reintroduced: The Prescription Pricing for the People Act directs the Federal Trade Commission to complete its ongoing study of PBM practices. The Pharmacy Benefit Manager (PBM) Transparency Act bans spread pricing, incentivizes PBMs to pass 100% of the rebates they receive to plan sponsors, encourages transparency, and requires annual reporting by PBMs of their pricing, reimbursement, and rebate practices. Other proposals go further, including the Patients Before Monopolies Act, which would ban PBMs and insurance companies from owning a pharmacy. The states have been busy as well, increasing their oversight of PBM practices through new legislation and reporting requirements. Unintended consequences of all of this are a concern for consultants and employers looking to control costs. In Colorado, Governor Polis signed HB 25-1094 into law in May. Effective in 2027, this law will regulate how PBMs can earn income, how they structure their formulary, and how they reimburse unaffiliated versus PBM-affiliated pharmacies, among other changes. Unfortunately, this new law won't apply to many large employer-sponsored healthcare programs. So large employers in Colorado are still left to design their own pharmacy strategy. Switching to a transparency-oriented PBM In recent years, more employers have switched their pharmacy programs to a new crop of PBMs who are unaffiliated with large insurers—including Navitus Health Solutions, Rightway Rx, Capital Rx, and SmithRx—and offer a more transparent business model. The advantages Pass-through pricing: Employers get the full benefit of network discounts and rebates, and instead of spread pricing, they pay a disclosed administrative fee per prescription. Fewer conflicts: The independent PBMs are less likely to have pharmacy operations or other business interests that differ from those of employers. Transparent disclosures: Employers get access to granular information about the pricing of each prescription rather than the opaque summaries provided by the large PBMs. Aggressive cost management: The independent PBMs emphasize lower net cost options in their formularies and have strict prior authorization requirements for more expensive drugs. The disadvantages Negotiating intermediaries: Since the upstart PBMs are small, many band together by using rebate aggregators, entities that negotiate lower prices with drug companies. But these negotiations have a downside: They can obscure the details of drug company rebates, especially since most of the aggregators are owned by the same insurance conglomerates that own the big PBMs. Potential disruption: Changing PBMs means employees must adjust to a new formulary, pharmacy network, and prior authorization procedures. Members may also object to the stricter utilization controls these companies use. Buying power: Smaller PBMs do not have the volume that the larger players do and are also unable to take on the risk of aggressive discount and rebate guarantees which can lead to a financial arrangement that appears to be less advantageous for employers. Renegotiating with your existing PBM Many companies that have investigated using a more transparent PBM ultimately decide that the advantages of sticking with a large provider outweigh the frustrations and potential conflicts. They are: Convenience: Dealing with one company that provides medical benefits, pharmacy benefits, and mail-order pharmacy service can be easier for employers and plan members alike. Lower effective prices: Some employers find that the greater bargaining clout of the large PBMs delivers good value even if the mechanics of their arrangements remain murky. Increased transparency efforts: Faced with the prospect of increased regulation, CVS Caremark, Express Scripts, and OptumRX have all announced programs that disclose more information about pricing and pass more of their rebates to employers. As they are just being instituted, their real-world impact remains to be seen. In any case, employers and their advisors can't afford to wait to scrutinize their PBM's business practices and press for more advantageous contracts. The time is now to: Look at the fine print: A typical PBM contract may specify high-level drug discounts, rebates, and dispensing fees. Dig deeper, and you can find exclusions and key definitions, such as what is a 'specialty drug.' Press for full pass-through of rebates: Work through every category and proposed exception to insist that rebates for all drugs go to the employer. Ask about conflicts: How does the PBM interact with its affiliated pharmacies? Are reimbursements different than those for independent pharmacies? Are the dispensed drugs made by brands it owns? Check its approach to cost control: What is its philosophy for adding drugs to its formulary? How does it generate prior authorization guidelines for drugs with high rebates? What percent of authorization requests are approved? Audit performance: At the end of a contract, demand a detailed itemization of all claims to ensure that the PBM has met its commitments. If it hasn't, fight for a financial adjustment. Whether your company decides to find a new PBM or renegotiate its deal with the current provider, there are a lot of details to consider. An experienced broker or consultant will help you sort through those complex contracts designed to confuse. And if Washington does end up passing PBM reform, that advisor will also be able to adapt your plan to take maximum advantage of the new rules. To learn more, contact Chris Mast, an actuary and benefits consultant with Alliant Employee Benefits in Greenwood Village, CO. Mast has worked with employers across Colorado and the US for more than 20 years. He can be reached at Alliant's Pharmacy team is made up of industry experts, pharmacists, and data specialists who provide marketplace perspective and insights, vendor capabilities, and practical knowledge to secure the best pricing and contract arrangements. Our buying power and partnerships enable us to support your benefits strategy, pharmacy program, and cost management throughout the entire program lifecycle. Learn more about Alliant at
