By George W. Chapman
First of all, TrumpRx does NOT sell drugs. It’s just a searchable website that directs you to the website of the drug company that manufactures the drug you want to purchase. If you know the manufacturer, you can go directly to the website bypassing TrumpRx. Typically, you will print out a coupon to present to your pharmacy. You still need a prescription. Second, at least so far, there are only 40 or so drugs in the plan. Odds are, what you’re looking for is not available. Third, it is CASH ONLY. If you are insured (commercial, Medicaid, Medicare, Tricare, etc) it won’t be covered. Cash spent will not be applied to your deductible or out-of-pocket maximum. So, it’s as if the transaction never happened as far as your insurance is concerned.
ACA Update: 1 Million Have Dropped Out
It’s beginning to look like 23 million people will not be getting a tax subsidy to help pay for their insurance purchased on the marketplace website. 93% of applicants qualified for a subsidy based on income. Without a subsidy, premiums will increase 114%. Already, one million have dropped out. Experts predict several million more will drop out once it’s clear congress is gridlocked for the foreseeable future. This will create an avoidable crisis for families as well as hospitals. Two thirds of the public believe the subsidies should be renewed ASAP.
Cost of Care in the U.S.
It could be the No. 1 issue on voters’ minds for the midterms. To put it into perspective, we spent $5.3 TRILLION on care in 2024. Our population then was about 340,000,000 for a per capita of $15,588.
H-1B Visa
To protect American workers, Trump increased the application fee to a whopping $100,000. Foreign healthcare workers, mostly physicians, are included. These physicians and allied professionals have been critical to staffing hospitals, health centers and nursing facilities. American physicians have worked side by side with foreign physicians for decades and few if any American physicians have complained about unfair competition from abroad. The $100,000 application fee is paid by the physician going into private practice or by the recruiting facility. In any event, it raises the already high cost of care. Consequently, the AMA, AHA and the Association of American Medical Colleges have petitioned the president to either waive the fee altogether or lower it back to $5,000.
No. 1 Patient Complaint: Prior Authorization
The Kaiser Family Foundation surveyed patients for their frustrations with our health system other than the obvious cost. 32% of respondents cited prior authorization. 23% cited confusing bills and explanation of benefits. So, what do I owe? 20% said getting an appointment when they needed one. 17% said finding participating providers covered by their insurance. Prior authorization, though, trumped all their frustration. People with chronic conditions that require ongoing treatment are especially impacted by denials, delays or alterations causing psychological and physical damage and increased financial worries.
Life Expectancy: We Placed 61st Out of 232
The U.N. updates the life expectancy of 232 countries annually. The 2025 report was just released. Several variables are considered, including: access to care, climate, pollution, sanitation, violence, guns, smoking and alcohol, diet, exercise, income, education and housing. But 50% of your life expectancy is impacted by your genetics, good or bad. Despite being the wealthiest country on the planet, we placed 61st out of 232. Our male-female combined life expectancy is just under 80 years at 79.76. The top five are: Monaco 86,73; San Marino 86.03: Hong Kong 85.9; Japan 85.15. Dead last (excuse the pun) is Nigeria just under 55 years at 54.95. Our breakdown by sex is female 76.4 and male 71.2.
Future of Medicare Advantage Plans
CMS paid Advantage plans last year about $13,000 per member. The money is transferred from the Medicare budget. Typically, CMS has raised the per member amount about 4% annually. Currently, half of the 60 million seniors are covered by Advantage plans. Advantage plans have been accused by CMS of “upcoding” the acuity level of their members in order to increase the amount received from CMS. In any event, CMS is forecasting the 2027 premium will only increase 1%. Clearly, CMS is sending a message to the insurance companies leading to a lot of speculation. Does CMS want to do away with Advantage plans? Will the carriers threaten to pull out altogether or reduce the number of markets they serve? If carriers begrudgingly accept the 1%, will they reduce the extra benefits not mandated by Medicare? Most likely, they will increase the monthly premium which in most markets is zero. One can bet they might increase prior authorizations, denials and delays. Stay tuned.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.