Health Care Facts

HEALTH CARE IN AMERICA COSTS TOO MUCH

Click to find answers to the most common health care questions

As premiums skyrocket and more than 3,400 prescription drugs increase in price, families are being forced to choose between paying for their prescriptions or paying their rent. There are a lot of solutions being proposed—but not all of them are equal. Health Care Facts is committed to making sure that everyday Americans understand the forces that are driving up health care costs and become part of the solution in addressing these costs.

WHY ARE MY HEALTH CARE COSTS SO HIGH?

ANSWER: One reason costs are rising is because of repeated and relentless attacks on existing health care laws—in Congress, by the Trump administration, and in the courts.

And that’s not all. Congress has failed to hold pharmaceutical companies accountable for skyrocketing drug prices. The pharmaceutical industry basically has free rein to set high drug prices, and then raise those prices–despite raking in record profits.

DRIVING UP PRICES NOW: Repeated attempts to repeal the Affordable Care Act have created uncertainty and destabilized the health insurance market. Insurance companies are pulling out of marketplaces in states across the country, leaving Americans with fewer options and driving up insurance premiums.

PROTECTING THE STATUS QUO: Because people have no choice but to buy the drugs they need—and because manufacturers have a monopoly on those drugs—pharmaceutical companies have been getting away with gouging consumers for years: They set high launch prices and regularly increase the cost of medication, even if the cost of manufacturing and distributing the medication hasn’t changed.

MAKING IT WORSE: Now, the Department of Justice has joined a court case to try to fully repeal the Affordable Care Act. If the Health Care Repeal Lawsuit succeeds, it will raise premiums by an additional 10 percent, allow health insurance companies to stop covering the cost of prescription drugs, and eliminate the annual limit on out-of-pocket health care costs.

Next >>

This is a graphic that debunks the claim that drug prices are high because pharma companies spend millions on research and development. In fact, they spend more on advertising and administrative costs

This graphic states that 130 million Americans could lose health coverage if the Affordable Care Act were repealed

WHAT IS THE HEALTH CARE REPEAL LAWSUIT (TEXAS VS. UNITED STATES OF AMERICA)?

ANSWER: When Congress passed the 2017 Republican tax law, it repealed a key section of the Affordable Care Act—setting the stage for a lawsuit brought by special interests, Republican attorneys general, and the Trump administration’s Department of Justice to strike down the ACA. Due to the uncertainty of the case, millions of Americans are unsettled about the future of their health care. If the Health Care Repeal Lawsuit succeeds, it could eliminate coverage for millions of Americans.

<< Previous

If the ACA is repealed:

Protections for 130 million Americans with pre-existing conditions will be eliminated.

Nearly 12 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.

2.3 million young adults will no longer be allowed to stay on their parents’ insurance until they turn 26.

Insurance companies will be able to charge women more for health coverage than men.

Insurance companies will be able to use more of your premiums for profits and CEO bonuses instead of more affordable health care.

Next >>

WHAT DOES A SOLUTION LOOK LIKE?

ANSWER: Right now, Medicare is banned from negotiating with drug companies to lower drug prices for all Americans. Those negotiations are illegal. One of the best ways to immediately and significantly lower drug prices is to lift that ban and give Medicare the power to negotiate for lower prices—and to make sure that those lower prices apply to every American.

<< Previous

The U.S. has the highest prescription drug costs in the world, in part because we're the only industrialized nation whose government doesn't negotiate with drugmakers over pricing. According to a new report, Americans pay as much as 67 times more than consumers in other nations for prescription drugs, even when accounting for rebates.

While people are paying too much for their drugs, pharmaceutical companies are raking in billions. In 2018 alone, the largest pharmaceutical companies made a combined profit of nearly $100 billion.

Giving Medicare the power to negotiate is one of the quickest and most effective ways to lower prescription drug prices. Combined with that policy, there are a few additional approaches that would further lower prescription drug costs—such as ensuring corporations do not abuse their monopoly power, holding corporations accountable for their business practices, and protecting laws that safeguard patients.

Next >>

This graphic states that Americans pay on average nearly 4 times more for drugs than other countries

This graphic states that allowing Medicare to negotiate drug prices would lower costs for consumers regardless of what health insurance plan they may be on.

WHAT ARE MEDICARE NEGOTIATIONS?

ANSWER: Medicare is one of the largest purchasers of health care and prescription drugs in the country. But since 2003, Medicare has been deliberately prohibited by Congress from negotiating for lower drug prices on behalf of consumers like you. Only Congress has the power to remove this ban and start driving drug prices down for the American people.

<< Previous

The 2003 Medicare law forbids the government and those who work at Medicare from negotiating with the big drug companies for lower drug prices on behalf of consumers.

Under the current system, negotiations are conducted between drug makers and pharmaceutical benefit managers, who negotiate on behalf of the private insurance companies. Therefore, under the current system, there is no advocate to represent you during these negotiations.

“Medicare negotiations” would resolve this problem. Medicare could represent and negotiate on behalf of all consumers, no matter what insurance plan you may be on, which would lower costs for every American.

Next >>

WHAT IS CONGRESS DOING TO HELP LOWER DRUG PRICES?

The House passed a plan put forward by Democrats that would give Medicare the power to negotiate lower drug costs and would lower those costs for millions of Americans.

The Lower Drug Costs Now Act (HR3) would finally allow Medicare to negotiate for lower drug prices with pharmaceutical companies, which would lower prescription drug costs for Americans. These lower drug costs would apply to consumers, whether or not they are covered by Medicare.

This proposal will stop Americans from having to pay double and triple the price for the same prescription drugs as others pay around the world.

This bill will create a new, $2,000 per year limit on out-of-pocket prescription drug costs for Medicare beneficiaries, and reverses years of unfair price hikes above inflation across more than 8,000 drugs covered by Medicare.

The Congressional Budget Office conducted an analysis of the Democrats’ plan and found that the Medicare negotiation portion of the bill would save Americans $456 billion over 10 years.

In the Senate, Chuck Grassley has proposed a bill that would alter parts of Medicare and Medicaid, but it does not give Medicare the power to negotiate lower prescription drug prices.

An amendment that would have given Medicare the power to negotiate for lower drug prices was blocked by Republicans on the Senate Finance Committee.

Critics of the Republican-sponsored plan note that it fails to control drug prices when a drug is first released or launched, and experts say the bill could actually result in higher launch prices. And once a drug launches at a high price, the prices tend to only get higher the longer the drug is on the market.

Importantly, the Republican-sponsored proposal affects only people on Medicare, so it won’t do anything to lower drug costs for anyone under 65.

The Congressional Budget Office's initial analysis of the proposal found that it would save more than $80 billion on drug spending over the next decade.

<< Previous

Next >>

WHY DOES ALL OF THIS MATTER?

ANSWER: The high price of health care and prescription drugs is putting people’s lives at risk. One in four Americans report they have difficulty paying for their prescription drugs, and one in eight report that they or a family member have rationed their medication due to high costs.

And if the Health Care Repeal Lawsuit is successful, many Americans will lose their coverage and health care costs for millions of people would rise.

<< Previous

Next >>

This graphic states that 1 in 4 Americans report difficulty affording their prescription drugs

WHY IS AFFORDABLE HEALTH CARE CRUCIAL DURING THE CORONAVIRUS PANDEMIC?

As the number of COVID-19 (coronavirus) cases in the United States rises each day, nearly 28 million Americans remain uninsured. Millions of Americans are less likely to seek treatment out of fear of cost. As we await the development of a vaccine and other treatment methods, Americans remain in the dark about whether these measures will be affordable. Continued attacks on our existing health care laws only exacerbate this problem.

<< Previous

Next >>

WHAT POLICY SOLUTIONS CAN HELP ADDRESS CORONAVIRUS?

During this pandemic, the Affordable Care Act (ACA) must be protected from ongoing repeal efforts that would end coverage for 20 million Americans and end protections for 130 million Americans with pre-existing conditions. In addition, CMS must re-open the open enrollment period in all 50 states so that people can more easily purchase the coverage they need, and Congress must provide additional funds to Medicaid.

In March of 2020, Congress passed 3 pieces of emergency legislation, establishing provisions for free testing, increased Medicaid funding, direct cash payments, and other forms of short-term relief. While these bills provide some immediate relief, additional measures to ensure longer term affordable health care are critical, including: