Obamacare Benchmark Premiums Up 75% Nationally from 2014-2024

 This week’s Paragon Pic demonstrates the growth in Affordable Care Act (ACA) benchmark premiums for single coverage from 2014 to 2024 by state and the variation across the country. Overall, benchmark premiums increased 75 percent between 2014 and 2024—more than 60 percent higher than the premium growth in employer plans during this time. The figure makes clear that premium growth has been very uneven across the country (a high of 201 percent in West Virginia to a low of 16 percent in New Hampshire) and that 2024 state benchmark premiums varied significantly.

The benchmark plan is the second-lowest-cost silver exchange plan and largely determines federal subsidies. The subsidies are structured so that the benchmark premium cannot exceed a certain amount of household income with higher subsidies for lower-income enrollees. Since benchmark premiums vary so dramatically across the country, so do subsidies. The contrast between neighboring states New Hampshire and Vermont makes this clear. Federal taxpayers are bearing a much greater cost for exchange enrollees in Vermont—largely because Vermont does not permit insurers to charge younger enrollees lower premiums than older enrollees, which significantly raises overall premiums.

There are numerous problems with the subsidies particularly after they were significantly increased by Congress through 2025, including that they lead to massive amounts of inefficient and fraudulent spending (as previous Paragon research has documented). One problem is a huge disparity that provides greater subsidy benefit in states that have higher premiums. In Follow the Money, Theo Merkel and I discussed this problem, recommending that Congress cap the benchmark premium at 125 percent of the national average for purposes of the subsidy calculation. From our paper:

“[T]he design of the actual credit is also inherently inflationary, as it is tied to premiums of a benchmark plan and caps an eligible enrollee’s premium contribution as a percentage of income. This means that, as premiums of that benchmark plan go up, taxpayers foot the bill. In areas where there is little or no insurer competition, this is especially problematic, as it effectively puts control of the subsidy amount to the insurer—the ultimate recipient of the subsidy.”

These downsides should be mitigated by instituting a cap on the benchmark plan used to calculate the PTC amount. The cap should be a percentage of the national average with some flexibility for geographic variation in cost of care. A benchmark cap at 125 percent of the national average should provide more restraint and would be a marked improvement over the status quo.

https://paragoninstitute.org/paragon-pic/obamacare-benchmark-premiums-up-75-nationally-from-2014-2024/

A Solution for Transparency-Averse Hospitals: Trust, But Verify

On August 23rd, Johnson & Johnson announced that disproportionate share hospitals serving low-income patients will receive 340B discounts on Xarelto and Stelara through rebates, rather than upfront discounts. Under this new arrangement, hospitals will receive 340B prices only after submitting certain medical, purchase and dispensing data.

In other words, “trust, but verify.”

HRSA (the Health Resources and Services Administration), the US Health & Human Services agency that oversees the 340B program, claims that the J&J plan is “inconsistent with the 340B statute,” which requires prior approval of such proposals … The Secretary has not approved J&J’s rebate model … and will take appropriate actions as warranted.”

In other words, trust but don’t verify.

Not surprisingly, a J&J spokesperson said the model is “fully consistent with the 340B statute, which specifically references rebates as a payment mechanism, and is expected to mitigate legally prohibited program abuses by improving transparency.”

The 340B program requires that drug manufacturers provide substantial discounts to eligible health care organizations that treat high numbers of uninsured and low-income patients. The problem is that the 340B program has become a slush fund for large nonprofit hospitals and health systems. They buy drugs at steep 340B discounts, then charge a huge markup. One of the results is shockingly little charity care.

Just how big is the 340B program? The numbers speak for themselves. Growing at a cumulative 129.4 percent over the past five years and reaching a year-end total of $124 billion in wholesale acquisition cost sales for 2023, the 340B program continues to expand at tsunami speed – and destructive force. To make matters worse, unlike programs such as Medicare Part D and Medicaid, 340B lacks a regulatory infrastructure, well-developed administrative controls, and clear legislation to guide the program.

In short, before we can trust, there’s plenty to verify.

Some hospitals treat 340B less as an assistance program and more as a profit-center. Their behavior is made possible by the fact that under current law, providers are under no obligation to pass through the discounts for needy patients or even report what they do with the savings. Just the opposite is happening. Eligible hospitals will obtain all their 340B medications from a drugmaker at the discounted 340B price and then bill privately insured patients -- and even uninsured patients -- for the drug's full list price, helping themselves to the difference as pure profit.

J&J’s plan (slotted to begin October 15) is designed to curb “rampant abuse and misuse,” while the federal government and large hospitals say “don’t worry, be happy – and don’t look behind the curtain.”

If you think this debate is topsy-turvy – that’s because it is. On the one side you have a large pharmaceutical company insisting on transparency based on an expedited trust but verify pathway. On the other you have hospitals and HRSA suggesting there’s no need to look under the carpet. After all, with all that money at stake via a sparsely staffed federal program that offers little oversight and a powerful lobbying organization – the American Hospital Association, arguing that everything is fine the way it is -- how could there possibly be anything untoward going on?

Why do hospitals hate transparency? Because they’re hiding some very dirty laundry. A February 2024 PatientRightsAdvocate.org report  found that just 689 (34.5%) of 2,000 hospitals it examined were fully compliant with federal price transparency rules. That’s down from 721 (36%) that were found to be fully compliant from the organization's last report, from July 2023. Per the new report, the most common reason for noncompliance was missing or significantly incomplete pricing data. And it’s getting worse -- the analysis found that 135 hospitals that were previously compliant are now noncompliant.

Hospital administrators should rightly be afraid of transparency. For too many years, too few policymakers paid any attention to the 340B drug discount program, blindly accepting the myth that non-profit hospitals and other covered entities were selflessly using 340B savings to “stretch scarce federal healthcare resources” in service of our most vulnerable patients.

Trust, but verify is sounding better all the time. Big Hospital – you can run but you can’t hide.

Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest and a Visiting Professor at the University of Paris School of Medicine.

https://www.realclearhealth.com/articles/2024/09/11/a_solution_for_transparency-averse_hospitals_1057695.html

Israel Offers To End War: Hamas Leader Sinwar To Be Given Safe Passage If All Hostages Returned

 Israel's top official who is overseeing the (so far) failed truce talks with Hamas has said Israel is ready to offer Hamas leader Yahya Sinwar safe passage if all the hostages are returned. Upon that condition, the war in Gaza war can come to an end, the senior official said.

This came direct from Israeli hostage envoy Gal Hirsch during an interview with Bloomberg published Tuesday. "I’m ready to provide safe passage to Sinwar, his family, whoever wants to join him," Hirsch said.

"We want the hostages back. We want demilitarization, de-radicalization of course — a new system that will manage Gaza," the top Israeli negotiator added. In essence he has stipulated that Hamas must agree to exit Gaza, and relinquish power there.

Hamas leader Yahya Sinwar, via AFP

Hirsch described that this unprecedented safe passage offer was put on the table less than 48 hours ago, but did not reveal whether a response was received or the nature of any Hamas reaction to it.

Yet he also admitted in the interview that the prospect of achieving a deal looks more and more unlikely. So the safe passage offer looks like a desperate last-ditch effort to get talks back on track.

Sinwar has long been seen as the mastermind behind the Oct.7 terror attacks on southern Israel. But even if the Hamas chief took up the offer, he would still remain on the run even abroad. This is because, as Bloomberg explains, Israeli intelligence has a proven history of tracking the movements of Hamas officials abroad and assassinating them:

It’s unclear whether Hamas would accept the proposal for Sinwar to leave Gaza, especially given Israel’s history of operations targeting operatives abroad.

Israel hasn’t taken responsibility for the assassination of Hamas leader Ismail Haniyeh on July 31 in Tehran. But Iran has said the killing — Haniyeh was slain in a bomb blast at a Tehran guest house — was Israel’s handiwork.

Hirsch continued by saying there are still other options even if Hamas doesn't agree to this big offer of safe passage for Sinwar. "In parallel, I must work on plan B, C and D because I must bring the hostages back home," he explained, adding that "The clock is ticking, the hostages do not have time."

Indeed the last six hostages to be recovered from the tunnels had been slain shortly before Israel's military (IDF) could reach them. This has outraged the hostage victims' families, who have also accused Prime Minister Netanyahu of being lukewarm in seeking the return of the captives. They say he's recklessly prioritized the military operation to defeat Hamas so much so that it's put the remaining some 100 hostages in danger.

Recent days have witnessed more record-breaking protests in Tel Aviv and Jerusalem:

Hamas has since warned that it will continue executing hostages if the IDF forces its way close to their locations. So the prospect of future daring military rescue raids returning hostages alive is looking more bleak.

https://www.zerohedge.com/geopolitical/israel-offers-end-war-hamas-leader-sinwar-be-given-safe-passage-if-all-hostages

Steward to Hand Off Hospital Operations Under Pact With MPT

  Bankrupt Steward Health Care won initial approval of a settlement with its landlord Medical Properties Trust Inc. that will resolve billions of dollars in lease obligations and hand over more than a dozen hospitals to new managers, averting their potential closing.

Judge Christopher Lopez said Wednesday he’d give interim approval to the settlement, a critical step to transitioning Steward hospitals to new operators. The pact also provides a path to distributing $395 million generated from the sale of Steward’s northern Florida hospitals to company lenders and lower ranking unsecured creditors.

Under the deal, Steward and its unsecured creditors committee agreed to drop potential claims against MPT in exchange for the real estate investment trust waiving substantial lease obligations, lawyers said during a court hearing. Transitioning the hospitals to new operators will save Steward from incurring additional operating expenses and averts potentially costly litigation, company lawyer Ray Schrock said.

Schrock said Steward will continue finalizing the settlement with various stakeholders in the coming days. Judge Lopez will consider giving final approval to the deal later this month. Steward announced the settlement on Aug. 30.

Steward’s failure has attracted scrutiny from state and federal lawmakers and put the company’s hospitals at risk. Last month, the bankruptcy court approved the closing of two of Steward’s Massachusetts hospitals. Steward sold its other hospitals in the state after Massachusetts provided emergency funding.

A Senate committee is scheduled to hold a hearing Thursday on the health system’s alleged mismanagement. The company operated about 30 hospitals in Florida, Massachusetts and other states when it filed Chapter 11 in May, and has been working to sell its hospitals to new owners.

The bankruptcy case is Steward Health Care System LLC, 24-90213, US Bankruptcy Court for the Southern District Court of Texas.

https://finance.yahoo.com/news/steward-hand-off-hospital-operations-160230360.html

ICYMI: 'DOJ charges Hamas leader, other militants over Oct. 7 attacks'

 The Department of Justice (DOJ) has charged Hamas leader Yahya Sinwar and other militants over the group’s Oct. 7 attack on Israel, Attorney General Merrick Garland announced Tuesday.

The charges, unsealed Tuesday, accuse Sinwar and other senior Hamas leaders of “financing and directing a decades-long campaign to murder American citizens and endanger the security of the United States.”

The criminal complaint, filed in federal court in New York City, includes seven counts, including charges of conspiracy to provide material support to a foreign terrorist organization, conspiracy to murder U.S. nationals and conspiracy to use weapons of mass destruction, resulting in death.

“In its attacks over the past three decades, Hamas has murdered or injured thousands of civilians, including dozens of American citizens,” Garland said in a video announcement.

Garland zeroed in on Hamas’s Oct. 7 attacks, during which the group killed about 1,200 people — including more than 40 Americans. About 250 others were kidnapped and taken back to Gaza, including about a dozen Americans.

“In the early morning hours of Oct. 7 last year, Hamas, led by these defendants, committed its most violent, large scale terrorist attack to date,” he added. “They perpetrated the deadliest massacre of Jews since the Holocaust.”

The Oct. 7 assault sparked the nearly 11-month war between Israel and Hamas in Gaza, during which Israel has killed more than 40,000 Palestinians and driven hundreds of thousands of civilians from their homes. Israeli leaders have remained steadfast in their goal of eliminating Hamas, a U.S.-designated terrorist organization.

Garland said the unsealed charges are “just one part” of the DOJ’s efforts to “target every aspect of Hamas’s operations.”

“These actions will not be our last. The Justice Department has a long memory. We will pursue the terrorists responsible for murdering Americans and those who illegally provide them with material support for the rest of their lives,” he said.

Garland pointed to the recent deaths of six more hostages in Gaza, including Hersh Goldberg-Polin, a native of Berkeley, Calif. The six hostages were shot at close range and died either Thursday or Friday before forces reached them in an underground tunnel in Rafah, according to Israeli health and military officials.

Their deaths prompted massive protests across Israel this week, as pressure grows on Israeli Prime Minister Benjamin Netanyahu to reach a cease-fire agreement with Hamas that would secure the release of the remaining hostages.

The charges come nearly a month after Sinwar was appointed as Hamas’s new leader following the assassination of top leader Ismail Haniyeh in Tehran last month. Sinwar is believed to be hiding in the vast tunnel network underneath Gaza.

Other Hamas leaders facing charges include Haniyeh; Marwan Issa, the deputy leader of Hamas’s armed bloc in Gaza who Israel claimed was killed in March; Khaled Mashal, a Haniyeh deputy and former Hamas leader; Mohammed Deif, the commander of the al-Qassam Brigades who is believed to have been killed in an Israeli airstrike in July; and Ali Baraka, Hamas’s head of national relations.

U.S. officials told The Associated Press at least one person, whom they did not name, is expected to be brought to New York for prosecution.

https://thehill.com/policy/international/4860594-doj-charges-hamas-leaders/

Ballot mailers: USPS changes could mean slower rural delivery

 Proposed operational changes within the U.S. Postal Service aim to financially stabilize the agency and improve service reliability, but critics say the plan discriminates against rural America.

The changes, which were announced last month but have not been approved, would entail faster service to customers within 50 miles of the Postal Service’s largest processing facilities. But for outlying areas, the change could add an additional day to delivery, though mail would still be delivered within five days or fewer across the continental U.S.

The proposed operational updates will modernize the ground transportation network to reflect changing customer needs, reduce costs to become financially self-sufficient and provide more predictable and reliable service, according to a USPS fact sheet.

For more than a decade, the postal service has operated under a broken business model that amassed more than $87 billion in losses from 2007 through 2020. The proposed actions are projected to reduce costs by approximately $3 billion annually.

Underpinning the plan is the need to pivot to a network built around both letters and parcels.

The USPS is introducing “Regional Transportation Optimization,” which is consolidation of delivery and collection activities. For post offices far from regional hubs, pick-up and drop-off of mail will occur primarily in the morning. Essentially, USPS would allow mail and packages to sit at certain facilities for an extra day instead of transporting them immediately for processing and delivery.

Many stakeholders who spoke during a pre-conference virtual hearing with USPS legal representatives and leaders Thursday said the changes discriminate against rural residents, who can live hundreds of miles from regional hubs. The lack of internet availability and seniors needing timely prescriptions force rural residents to heavily rely on the postal service, they added.

USPS panelists stressed most customers will see the same or upgrades in service, while 6% are expected to experience downgrades. They also noted medications also should continue to be delivered at their current speed, or faster, under the proposal.

“Delivery for approximately 75% of first-class mail will not be impacted by the refinements to our current service standards, and around two-thirds of mail will be delivered in three or less days,” according to USPS. “All first-class mail and USPS ground advantage will continue being delivered within five days. Our other products, like marketing mail and periodicals, will also see improved service standards, with the day ranges for those products being shorter overall than they are today.”

Three years ago, Postmaster General Louis DeJoy announced the 10-year Delivering for America plan, but practices continue to reflect a Postal Service designed for three decades ago, he said.

Many central and southern Illinois residents can attest to breakdowns in the network. U.S. Rep. Mike Bost, R-Murphysboro, has received more than 250 complaints about postal service since January from nearly every one of the 34 counties in his congressional district.

“Southern Illinoisans have been consistently facing delivery delays, missing mail and significant problems that all link back to the USPS St. Louis Distribution Center,” Bost said on X following a visit to the distribution center to discuss ways to work together to find a resolution. “This has caused serious disruptions, like delayed medications or utility bills, late fees and even the loss of cremated remains. This widespread problem is not just a service failure but a violation of trust, and it demands accountability and urgent reform.”

Illinois Farm Bureau President Brian Duncan sent a letter to DeJoy in March about the consequences of a proposal to transfer Peoria’s mail sorting operations to suburban Bedford Park. USPS officials have announced similar changes for facilities in Champaign, Springfield and the Quad Cities.

IFB members also consistently rely on the news and market information contained within FarmWeek to make important decisions about their farming operations, Duncan wrote.

U.S. Rep. Nikki Budzinski, D-Springfield, criticized DeJoy’s proposal.

“From prescriptions to letters from loved ones, mail is essential for folks to stay connected,” she said on X. “Postmaster DeJoy has no business slowing service in areas already struggling to receive mail on time — including rural communities in central and southern Illinois.”

The Postal Service will consider the comments received during the virtual conference and will file its formal request asking for an advisory opinion from the Postal Regulatory Commission (PRC). After receiving an advisory opinion from the PRC, the Postal Service will consider the commission’s opinion and finalize its decision. The changes would not be implemented until 2025.

https://www.farmweeknow.com/general/usps-changes-could-mean-slower-rural-delivery/article_24fc099e-6bbc-11ef-9358-bbf1fd1798b7.html

'US intell: Amid efforts to influence the election, 2024 contest remains secure'

 The intelligence community has determined that no foreign adversary has yet attempted to impede government efforts to carry out the 2024 election, even as they otherwise seek to amplify U.S. divisions.

“Our assessment is that it would be very difficult for foreign actors to manipulate election processes at a large enough scale to impact the outcome of a federal election without detection,” an official from the Office of the Director of National Intelligence (ODNI) told reporters Friday.

The call was the agency’s first since Iran successfully hacked Trump campaign emails and also comes after the Justice Department announced a series of measures and indictments targeting Russian efforts to influence the election.

Iran has been more brazen this election, ramping up its own efforts. 

“Iran is making a greater effort than in the past to influence this year’s elections, even as its tactics and approaches are similar to prior cycles,” ODNI noted in a report assessing election security 60 days ahead of the contest. 

“Tehran also has sought cyber access to individuals with direct ties to the presidential campaigns of both political parties while elements have also denigrated the former President. … Beyond attempts to hack and leak information, Iran is conducting covert social media operations using fake personas and using AI to help publish inauthentic news articles.”

Russia, however, remains the predominant threat when it comes to efforts to influence the election, working to target a number of different races beyond the presidential race.

“The scope and the scale of their activities are quite significant,” an official said on the call. “Russia is working up and down ballot races as well as spreading divisive issues.”

They went on to describe them as “fairly robust and quite practiced at doing this type of activity.”

Officials also cautioned that the public should not take at face value Russian President Vladimir Putin’s claims he was backing Vice President Harris in the race.

“The [intelligence community] does not take Putin’s public statements as representative of Russia’s covert intentions. There are many examples over the past several years where Putin’s statements do not align with Russian actions, for example his comments that he would not invade Ukraine,” an ODNI official said.

Speaking at the Eastern Economic Forum in Vladivostok earlier this week, Putin expressed support for Harris as well as President Biden.

“Our ‘favorite,’ if you can call it that, was the current president, Mr. [Joe] Biden. But he was removed from the race, and he recommended all his supporters to support Ms. Harris. Well, we will do so — we will support her,” Putin said. “She laughs so expressively and infectiously that it means that she is doing well.” 

Officials pointed to a recent action by the Justice Department to seize 32 different websites used by Russia to sow division and push Russian viewpoints.

A dual-language internal planning document titled “The Good Ol USA Project,” shared by the Justice Department, stresses the need to secure Republican candidates, particularly former President Trump.

It also brought charges against two Russian citizens working for RT, formerly known as Russia Today, for partnering with a U.S. media company to hire influencers to spread other approved rhetoric.

https://thehill.com/homenews/campaign/4866723-2024-presidential-election-secure/