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OPINION
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gainesvilletimes.com
Saturday, December 8, 2018
Shannon Casas Editor in Chief | 770-718-3417 | scasas@gainesvilletimes.com
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Health care
mergers are
a poison pill
for patients
BY ANTHONY GALACE
Tribune News Service
Big corporations often tout their mergers as pro
moting efficiency and helping consumers, but too
often the public ends up with fewer choices and
higher prices. That seems likely to happen again
with the latest health care megamerger.
CVS Health and Aetna Inc. recently finalized a
$70 million merger, combining one of the nation’s
largest pharmacy chains with one of its largest
insurers. The companies promise a new and inno
vative form of health care, with cheaper medica
tion and shorter wait times.
But even though the deal has won approval
from the U.S. Justice Department and 28 state
regulators, physicians, patients, economists, and
advocates aren’t buying it. The American Medi
cal Association, American Antitrust Institute and
leading economists across the country warn that
this merger will do nothing to curb rising prescrip
tion drug costs, stagnating health coverage rates
or deteriorating quality of care. In fact, they say
it may worsen health care disparities between
disadvantaged communities and more affluent
populations.
CVS’s newfound power could significantly
reduce competition by driving independent phar
macies out of business and forcing other large
pharmacy chains to consolidate — driving up
prices and increasing premiums and out-of-pocket
costs for seniors and low-income patients. Further
more, this merger will likely force patients with
health coverage through Aetna to purchase their
medication from a CVS pharmacy, taking away
their right to choose.
Earlier this year, testifying before the Califor
nia Department of Insurance, CVS claimed that
its acquisition of Aetna would result in “efficien
cies” (read: savings/profits) worth $750 million
per year, allegedly by streamlining administrative
expenses and negotiating better prices with phar
maceutical companies.
But when asked at the hearing I attended
whether these savings would be passed along to
patients, CVS was mum. The company’s rep also
could not say how it planned to make medication
more accessible to low-income and underserved
communities, especially those located far from
a hospital or clinic. We also asked whether they
would expand their contracting with minority-
owned businesses, diversify their governing board
and senior executives, and add stores in low-
income neighborhoods. Their response: Ask us
after our merger.
In 2016, the U.S. Department of Justice under
the Obama administration blocked two high pro
file health insurance mega-mergers — between
Aetna (yes, the same one) and Humana, and
Anthem and Cigna. Both would have obliterated
competition in insurance, giving patients and pro
viders across the country little choice but to accept
their prices and payments. These mergers would
have likely priced many low-income Americans
out of health coverage.
In retaliation for blocking their merger, Aetna
pulled out of the Affordable Care Act exchanges
entirely, abandoning thousands of patients.
Now they expect us to believe they’ll do better.
Color us skeptical.
All this comes on the heels of another recently
approved merger between another large phar
macy chain and health insurer — Express Scripts
and Cigna. Given the growing trend of consolida
tion among health care companies, expect these
companies to continue to sell the same old story
that has never come true: Give us more power,
and we’ll be better, we promise. Advocates and
regulators shouldn’t buy such promises.
Your government officials
Georgia state government
Gov. Nathan Deal, 203 State Capitol, Atlanta
30334; 404-656-1776; www.gov.georgia.gov
Lt. Gov. Casey Cagle, 240 State Capitol, Atlanta
30334,404-656-5030; www.ltgov.ga.gov
Secretary of State Brian Kemp, 214 State
Capitol, Atlanta 30334, 404-656-2881,
fax 404-656-0513; www.sos.state.ga.us;
Elections Division, 2 MLK, Jr. Drive SE, Suite
1104, West Tower, Atlanta 30334-1530, 404-
656-2871, fax, 404-651 -9531
Attorney General Chris Carr, 40 Capitol Square
SW, Atlanta 30303; 404-656-3300; law.ga.gov
School Superintendent Richard Woods, 205
Jesse Hill Jr. Drive SE, Atlanta 30334; 404-
656-2800; www.doe.k12.ga.us; askdoe@
gadoe.org
Labor Commissioner Mark Butler, 148 Andrew
Young International Blvd. NE, Suite 642,
Atlanta 30303-1751; 404-656-3045, 877-709-
8185; www.dol.state.ga.us
Insurance Commissioner Ralph Hudgens, 2
Martin Luther King Jr. Drive, Suite 704, West
Tower, Atlanta 30334; 404-656-2070; oci.
georgia.gov; inscomm@mail.oci.state.ga.us
Agriculture Commissioner Gary Black, 19 Martin
Luther King Jr. Drive, Room 226, Atlanta
30334; 404-656-3600, 800-282-5852; agr.
state.ga.us; info@agr.state.ga.us
Public Service Commission, 244 Washington
St. SW, Atlanta 30334-9052, 800-282-5813,
gapsc@psc.state.ga.us, www.psc.state.ga.us.
Chairman Chuck Eaton, District 3; Tim Echols,
District 2; H. Doug Everett, District 1; Vice
Chairman Lauren “Bubba” McDonald, District
4; Tricia Pridemore, District 5
Gov. Nathan Deal is proof
that nice guys can finish first
I dropped by Gov. Nathan
Deal’s office recently for a
visit. In little over a month-
and-a-half, our 82nd governor
will be our newest former
governor. My timing could
not have been better. The
governor seemed happy to
see me. (Not the kind of reac
tion I usually get from many
of our public officials.) What
was supposed to be a 30-min-
ute appointment stretched
to almost an hour. Good for me. Bad for
those in charge of scheduling his time.
I asked the governor his reaction to the
just completed governor’s race. “I am glad
it is over,” he laughed. Aren’t we all. On
a serious note, he said it was obvious that
our current election laws will be a major
debate going forward. The governor cau
tioned that whatever changes are consid
ered will likely be expensive and can’t be
accomplished overnight or perhaps even
within the next two years. But it is an issue
that is not going away. Be prepared.
In my not-so-humble opinion, Deal has
been a good governor. There were a few
bumps in the road along the way — an
ethics investigation while still a member
of Congress, questions regarding pay
ments to his daughter-in-law’s fundraising
company during his re-election campaign
and the famous — or infamous — Snow-
mageddon debacle of 2014.
Today as he prepares to leave office,
Deal’s approval ratings are extremely
high. A recent survey by the Atlanta
newspapers showed that more than 85
Republicans in the state approve of his
performance as well as 48 percent of
Democrats. Want further proof of his pop
ularity? In one of the most acrimonious
partisan elections in memory, Democratic
gubernatorial candidate and former
House minority leader Stacey Abrams ran
television ads touting her good working
relationship with the governor.
And why not? He leaves
office with the state in excellent
financial health. The state’s
Quality Basic Education for
mula for K-12 was fully funded
for the first time ever and he
has instituted a major overhaul
of our criminal justice system,
making it one of the best if not
the best in the nation. (Note:
I am a member of the State
Board of Juvenile Justice.) He
has also appointed more judges in his time
in office than any governor in history.
He proudly points out the expansion of
the HOPE Grant, a scholarship that pays
100 percent of tuition for students to attend
technical colleges to learn skills that are in
high demand for Georgia’s workforce as
well as establishing the REACH Georgia
Scholarship, a public-private partnership
that provides scholarships to promising
middle school students from low-income
families.
He has dealt with the tough decisions a
governor has to make without engaging
in the shrill name-calling and denigra
tion that seem to be a part of the current
political environment. He vetoed the
Religious Liberty bill passed by the Gen
eral Assembly. He restored the tax cut to
Delta Air Lines by executive order after
legislators dropped it in retaliation for
Delta halting a discount program with the
National Rifle Association. (The Legisla
ture restored the tax break during their
recent special session.) In both cases,
the response to his decisive actions was
remarkably mute. It is obvious that the
governor walks softly but has a big stick
and knows how to use it.
How has he managed to get things done
without threats and tub-thumping? “My
wife (first lady Sandra Deal) is always
reminding me to be nice,” he laughs.
Then adds, “I think you should always
try to educate before you advocate.” The
governor says he tries to let the public and
lawmakers know what he is proposing and
why, and then getting their input.
One of the examples he uses is the com
prehensive transportation bill passed in
2015 to maintain and repair Georgia roads
and bridges that required an increased
gasoline tax and an extra fee on hotel
stays.
On the other hand, an attempt at an
Opportunity School District, which would
have established an office for a second
state superintendent who would have
reported to the governor, was soundly
defeated by voters in a referendum. “We
got out ahead of ourselves on that one,” he
admits. Since then, the General Assembly
has passed a similar concept creating a
“turnaround officer” to work with under-
performing schools but under the control
of the local school districts.
With a change in administrations upon
us, the state looks like the proverbial duck
— gliding smoothly on the surface but
paddling like the dickens under water. It
is called the transition period. Gov.-elect
Brian Kemp has a team on hand working
with those in Gov. Deal’s administration
and getting ready for the handoff. “I am
not there to intrude but will help if the
governor-elect asks,” Deal said. “Gov.
(Sonny) Perdue was extremely helpful to
me in our transition and I hope I can do
the same for Gov.-elect Kemp.” I would
suggest Kemp listen closely to the man. He
has big shoes to fill.
With that, we switched gears and talked
about how Deal got from his boyhood
home in Sandersville to the highest office
in the state. More on that next week.
Dick Yarbrough is a North Georgia
resident whose column regularly appears
Saturdays. Contact him at P.0. Box
725373, Atlanta, GA 31139; online at
dickyarbrough.com; or on Facebook.
DICK YARBROUGH
dick@
dickyarbrough.com
"Leave that thermostat alone! You've
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