DCMedical News: Tuesday, November 2, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, November 2, 2021
Infrastructure May Pass, Social Spending Waiting
Politico reports (here) that “The infrastructure measure is mired in the House awaiting an elusive consensus on the social spending measure. And the longer that both bills sit in the House, the more those centrist and liberal wings forget why they got engaged in the first place. Sen. Joe Manchin (D-W.Va.) today bluntly told the House that “it’s time to pass” the infrastructure bill. Days after they balked at exactly that vote, progressives now sound ready to heed his instructions — even as the social spending bill they wanted to wait for is no closer to quick passage than it was last week.”
But The Hill reports (here) that “Democratic negotiators in the House say they’re on the brink of sealing a deal on President Biden’s economic agenda despite Sen. Joe Manchin (D-W.Va.) tossing a verbal hand grenade into the talks on Monday. Democrats brushed aside concerns voiced by Manchin at a must-watch press conference that the $1.75 trillion package might exacerbate inflation, insisting the measure would improve the economy. They also vowed to plow ahead with their strategy for moving both the broader spending bill and a separate bipartisan infrastructure measure through the House, effectively ignoring Manchin’s demand for a swift vote on the latter.”
Early Christmas or a Block of (West Virginia) Coal: Major Health Insurance Elements in “Build Back Better”
Georgetown’s Sabrina Corlette and the Center on Health Insurance Reforms summarize (here) major health insurance provisions in the Administration bill. Corlette writes that by adding three years (through 2025) to premium subsidies, “This means that families with incomes between 100 and 150 percent of the federal poverty line (FPL) have their premium contribution reduced to $0 if they purchase a benchmark plan. Families with incomes over 400 FPL have their premium contribution capped at 8.5 percent.” The subsidies, through the American Rescue Plan, “Enabled 2.1 million new people to sign up for coverage in 2021, and are projected to help over 3 million more.”
Other insurance benefits outlined in Corlette’s blog include filling the Medicaid gap via the Marketplaces; expanding services required of Marketplace insurers, such as non-emergency transportation; incentives for states that have expanded Medicaid to retain their expansions; increasing the affordability of employer-based insurance through premium tax credits; additional premium tax credit and cost sharing assistance for the unemployed; grants to states to enhance affordability through reinsurance or reducing in cost sharing; and more, read the blog. Writes Corlette, “Christmas is coming early this year, folks.”
And from Georgetown’s Health Policy Institute (here) a discussion of how the “Build Back Better Reconciliation Bill Would Take Big Strides in Expanding Health Coverage and Access for Children and Families.”
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Texas Medical Association Sues HHS to Stop Implementation of No Surprises Act
The Complaint (here) takes exception to HHS’ publication in September and October of rules for implementation of the No Surprises Act (NSA) without procedural guarantees of the notice and comment period and the process for public input under the Administrative Procedure Act. It also outlines substantive differences between doctors and insurers, for example, “Departments’ methodology for calculating the QPA [“qualifying payment amount,” generally the median of the payor’s contracted rates for the relevant item or service, as calculated by the payor] includes certain contracted rates that will often cause the QPA to understate the true market value of providers’ services . . . For example, insurers may require primary care doctors to include rates for emergency room services in their contracts, even though they do not provide those services and thus lack the incentive to negotiate a true market rate. Yet the Departments not only count those rates in calculating the QPA, but give them equal weight with rates that are used frequently.” The medical association contends that calculation of the QPA is essentially a “black box,” opaque and not available for review.
29 U.S. Senators Weigh In on Prior Authorization
In a letter (here) to CMS, the group recounted the on-again, off-again, CMS initiatives to relieve physicians and other providers of the burden of obtaining prior authorization. “In December 2020, CMS issued a proposed rule to modernize processes related to prior authorization that would reduce significant burdens on health care providers and patients and improve patient outcomes . . . To our disappointment, CMS formally withdrew these proposed changes to the prior authorization process in March 2021.”
However, “More recently, CMS issued a memorandum to MA [Medicare Advantage] plans, strongly encouraging all MA plans to waive or relax prior authorization requirements and utilization management processes related to COVID-19 . . . As you have stated to Members of Congress, ‘providers and beneficiaries should not have to jump through unnecessary hoops for access to medically appropriate care.’”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Hospitals and Freestanding Emergency Departments Have Admissions Under State Control in Colorado
Governor Polis has re-issued (here) an “Executive Order authorizing the Colorado Department of Public Health and Environment (CDPHE) to order hospitals and freestanding emergency departments to transfer or cease the admission of patients to respond to the current disaster emergency due to coronavirus disease 2019 (COVID-19) in Colorado.” First issued in November, 2020, this new 30-day Order also authorizes the transfer of patients from one facility to another, without the consent of the patient or the facility to which the transfer is being made.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Meets Next Monday and Tuesday, November 8-9
The Medicare Payment Advisory Commission (MedPAC) holds a virtual meeting, beginning Monday at 11:15 a.m., with a session on "Benchmark incentives for accountable care organizations" (meeting brief here); followed (1:45 p.m.) by “Medicare payment policies to support safety-net providers” (meeting brief here); and "Telehealth: Updates on use, beneficiary and clinician experiences, and other topics of interest" (meeting brief here).
DRUGS & DEVICES
The Gross to Net “Bubble” in Prescription Drug Prices
Adam Fein’s Drug Channels reports (here) on the “annual update on pricing at six of the largest pharmaceutical manufacturers—Eli Lilly, GlaxoSmithKline, Janssen, Merck, Novartis, and Sanofi” with links to each company’s data. Writes Fein, “When rebates and discounts were factored in, brand-name drug prices declined—or grew slowly—in 2020. Consistent with our previous analyses, rebates and discounts reduced the selling prices of brand-name drugs to less than half of their list prices. What’s more, net drug prices have declined for the past four years.”
READINGS & REFERENCES
Incompetence or Guile: NYT Opinion Piece Examines the “Lab Accident” Theory
A fourteen-page Opinion in The New York Times (here) examines the lab accident theory behind the outbreak of COVID-19. The history of lab leaks is suggestive: “Nearly every SARS case since the original epidemic has been due to lab leaks — six incidents in three countries, including twice in a single month from a lab in Beijing.” Scientists change their minds: “Several scientists who signed The Lancet letter denouncing the consideration of anything but natural origins have since said they are more open to lab involvement. One, Bernard Roizman, an emeritus virologist at the University of Chicago with four honorary professorships from Chinese universities, said he was leaning toward believing there was a lab accident. ‘I’m convinced that what happened is that the virus was brought to a lab, they started to work with it,’ he told The Wall Street Journal, “and some sloppy individual brought it out.’ He added, ‘They can’t admit they did something so stupid.’”
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November 3, 4, 5, 15, 16, 17, 18, 30
December 1, 2, 3, 6, 7, 8, 9, 10
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org