DCMedical News: Friday, January 27, 2023
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Friday, January 27, 2023
Sixteen Million Sign Up for PPACA Exchange Plans, Seventeen Million in Peril of Losing Medicaid
Sixteen million people signed up for health insurance plans through the exchange/marketplace policies of the Patient Protection and Affordable Care Act in the 2023 enrollment period. This is a 13% increase, and includes 3.6 million first-time enrollees.
InsideHealthPolicy reported (here) that “The numbers include 12.1 [million] plan selections made through the 33 states that use healthcare.gov and 4.1 million made through the 17 states, and District of Columbia, that run their own exchanges . . . HHS Secretary Xavier Becerra said enrollment is about 50% higher since President Joe Biden took office, noting that about 11 million people were enrolled only a few years ago. Becerra also pointed out the large numbers of enrollees in several states, including Florida (3.2 million), Texas (2.4 million) and North Carolina (800,000).”
Coverage in The Wall Street Journal (here) noted that “The rise in enrollments has helped lower the number of uninsured people under age 65, which fell to a record low of 8% in early 2022 from 10.5% in 2021 and 11.1% in 2019 . . . In 2009, the year before the ACA was enacted, 17.5% of people under the age of 65 lacked insurance,” and also that “The subsidies have helped buffer many health-plan shoppers from escalating premiums in 2023, increases largely propelled by inflation and more use of healthcare. Insurers on the ACA marketplaces proposed median monthly premium hikes of 10%, according to a review of more than 70 insurers in 13 states by the Kaiser Family Foundation.”
Coverage in The New York Times (here) emphasized the affordability of plans, noting “Under the new policies enacted during the pandemic, which were renewed through 2025 in the climate, tax and health care bill passed last year, subsidies increased at every level of income. Americans earning less than 150 percent of the federal poverty level — around $42,000 for a family of four — are eligible for free health plans that come with low deductibles and co-payments. Before the change, many such people could get free plans on the Obamacare marketplaces, but only with very high deductibles. This year, there were particularly large increases in sign-ups in Texas, Florida, Georgia and North Carolina — states with large low-income populations that have not expanded Medicaid, suggesting the new subsidies are driving the change.”
Medicaid Disenrollment Begins—FTC OKs Texting
At the same time, disenrollment from Medicaid may result from the re-establishment of Medicaid program eligibility. HHS has indicated that it expects 7 million people may be dropped as a result of the 14 month long process. Other observers believe 17 million may be lost. The Federal Trade Commission (here) has approved disenrollment by text message.
IHP reports (here) on the process: “Medicaid beneficiaries have been continuously enrolled during COVID-19 as a condition of their states receiving a 6.2% increase in federal Medicaid matching funds (FMAP). Congress’ goal with the so-called maintenance of effort was to keep Americans insured during the pandemic, and over the last three years, Medicaid and Children’s Health Insurance Program enrollment has ballooned to more than 90 million enrollees.”
“This has created a herculean task for states, which are now tasked under Congress’ year-end spending package with restarting their normal redetermination processes as early as February. States can begin dropping Medicaid beneficiaries from coverage as soon as April 1. Advocates are concerned if states aren’t careful during the unwinding period, 16 million beneficiaries’ coverage could be at risk, including the coverage for at least 6.7 million children.
States have 12 months to begin redetermining each beneficiary’s eligibility and 14 months to complete the process, but states must process a fresh renewal for each beneficiary; this means Medicaid staff can’t use eligibility information obtained before February during the unwinding period.”
“Further complicating states’ efforts, one in four state Medicaid programs has a staff vacancy rate that is greater than 20%.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare Drug Price Negotiation Program
The Inflation Reduction Act (IRA) authorized a new program under which, beginning in 2026, Medicare will negotiate a limited number of prices for drugs. In a memo (here) “The Centers for Medicare & Medicaid Services (CMS) is taking its first steps toward implementing the Medicare Drug Price Negotiation Program . . . The IRA authorizes Medicare to directly negotiate drug prices for certain high expenditure, single source Medicare Part B or Part D drugs. For the first year of the Negotiation Program, the Secretary will select 10 Part D high expenditure, single source drugs for negotiation. The maximum fair prices that are negotiated for these drugs will apply beginning in initial price applicability year 2026.”
Healthy Congress? Healthy Congressional Districts
A new Congressional District Health Dashboard (CDHD, here) is an online data tool that provides health data for 435 US congressional districts and the District of Columbia. A press release from the sponsors notes that “The tool incorporates 36 critical measures of health and its drivers, such as deaths from breast cancer and cardiovascular disease, diabetes rates, housing affordability, and access to nutritious foods.” Also, “users can explore data on health, poverty, education, and other factors by congressional district and compare the rates of these metrics among demographic groups within districts.”
DRUGS & DEVICES
Amazon Jumps In, Again
Amazon is making yet another foray (here) into the health field, looking now to develop “subscribers” for generic drug purchases. “Amazon.com Inc said on Tuesday it is offering a $5 monthly subscription plan for U.S. Prime members that will cover a range of generic drugs and their doorstep delivery, furthering the ecommerce giant’s push into healthcare.
The program, named RxPass, includes more than 50 medications addressing over 80 chronic conditions such as high blood pressure, anxiety, diabetes and male pattern baldness.”
In May, Axios reported (here) that “With little fanfare, Amazon recently launched its most significant foray into clinical health yet: the expansion of its Amazon Care telehealth service nationwide and in person care services to more than 20 cities this year . . . Amazon has been pushing into the health care space for years, starting with its wearable health device, Halo and pharmacy services with its PillPack acquisition . . . Amazon is among many nontraditional health care businesses to make inroads into virtual care, joining Verizon, Dollar General, Best Buy and more.”
Direct to Consumer Television Advertising Faulted for Promoting Low Value Drugs
A study in JAMA Network Open (here) found that “Direct-to-consumer drug advertising increased by nearly 5-fold from 1997 to 2016, with 663,000 television commercials reported in 2016” and that “Fewer than one-third of the most common drugs featured in direct-to-consumer television advertising were rated as having high therapeutic value, defined as providing at least moderate improvement in clinical outcomes compared with existing therapies.”
“The findings of this study are consistent with prior research that questioned the therapeutic value of drugs heavily promoted to clinicians . . . The American Medical Association and public health advocates have called for restrictions on direct-to-consumer drug advertising, warning that it inflates demand for newer, more expensive drugs at the expense of less costly alternatives.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 30, 31
February 1, 2, 6, 7, 8, 9, 27, 28
March 1, 7, 8, 9, 10, 22, 23, 24, 27, 28, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org