DCMedical News: Wednesday, March 7, 2018
DCMedical News
Washington, D.C.
Wednesday, March 7, 2018
To our new readers: This is an independent newsletter, published every day that one or another House of Congress is in session. Past issues can be accessed by clicking on “View this email in your browser.” Subscription information is found at the bottom of these pages. Trial subscriptions may end without notice.
THE BIG STORY TODAY IN HEALTH CARE
The States:
Innovation in Medicaid a focus for speakers at the CQ Roll Call event Tuesday. Milbank simultaneously published caution about the romance of state action (“Mad About States,” here, by Obamacare historian John McDonough) and the likelihood of any transformative innovation at all (“Curb Your Enthusiasm” from Burns and Pauly, here).
Farm Bureau plans: two states making “skinny health insurance plan” news had in common the use of their Farm Bureaus, Tennessee (here) and Iowa (here, profile from the Des Moines Register), with programs deemed by their states not to be insurance at all.
The Budget:
Twelve Congressional work days remain before expiration of the current Continuing Resolution (government funding) and the expected delivery of appropriations bills for FY 2018 and FY 2019.
The “Omnibus” spending bill will appear in draft soon. Add-ons will, in theory, require off-sets. GW’s Sara Rosenbaum (“Now Welfare Reform, Of Course,” here) writes that “As night follows day, the Trump administration and Congressional leaders have announced that they intend to use welfare reform to finance their historic tax legislation.”
One prospective omnibus passenger: the return of Cost-Sharing Reduction payments, less expensive, according to OMB, than reinsurance would be, and capable of lowering premiums 15-20%. Writing (here) in favor of both C-SR payments and reinsurance were the AMA, AHA, AHIP, BCBS and the U.S. Chamber of Commerce.
HEALTH INSURANCE, MEDICARE, MEDICAID, COMMERCIAL
HHS Secretary Azar to the Federation of American Hospitals Monday: “The only option is to charge forward — for HHS to take bolder action, and for providers and payers to join with us.”
Also, the Secretary’s reaction today to announcement by UnitedHealth that United will share the wealth (drug manufacturer rebates and discounts) with patients at the pharmacy level: “Today’s announcement by UnitedHealthcare is a prime example of the type of movement toward transparency and lower drug prices for millions of patients that the Trump Administration is championing.” The sharing will commence in 2019, for fully underwritten plans, and self-insured plans that so choose. Not so transparent: United shareholders can “rifle through 12 years of the payer’s records to support allegations UnitedHealth directors partook in Medicare fraud,” per Bloomberg Law. Two pension funds and a bank sued, on grounds (code creep to boost risk scores) already discarded by the Department of Justice in FCA suits.
Medicaid: CMS Tuesday released (https://www.medicaid.gov/medicaid/eligibility/medicaid-enrollees/index.html) poverty standards for dual-eligibles, CHIP, other income-linked programs, also found here.
PPACA: a new Commonwealth Fund issue brief (here) examined five (relatively rural) states — Alabama, Alaska, Oklahoma, South Carolina, and Wyoming — that had only one insurer participating in the marketplaces in 2017. The findings and conclusions (essentially a history of health “reform” 2010-2016):
“In 2010, the individual insurance market was already concentrated in the five study states, with Blue Cross and Blue Shield (BCBS) plans covering the majority of enrollees. By 2015, with the marketplaces in full swing, more issuers were competing in the five states. But by 2016, co-ops were facing bankruptcy and left the marketplaces in these states; and in 2017, citing large financial losses, national issuers UnitedHealthcare, Aetna, and Humana also exited, leaving only a single BCBS plan in each state. Three of the five states experienced substantially higher annual premium increases than the national average. Policy options with bipartisan support, such as resuming cost-sharing reduction payments and reestablishing reinsurance and risk corridors, could help attract new or returning issuers to marketplaces in these states.”
PHARMA
Opioids:
Data from emergency departments (EDs) show that the U.S. opioid overdose epidemic continues to worsen, according to the latest Vital Signs [found here] report by the Centers for Disease Control and Prevention (CDC). ED visits for suspected opioid overdoses increased 30 percent in the U.S., July 2016-September 2017, 70% in the Midwest and 54% in sixteen large cities.
But not everyone is on board concerning “solutions”: STAT reports a last minute flurry of activity in opposition to proposed CMS limits on the prescribing of pain pills to Medicare beneficiaries: “Dozens of other academics, doctors, and editors of pain journals have signed on to a letter claiming the proposed rule constitutes overreach by CMS into medical treatment and would carry serious consequences for the 1.6 million Medicare beneficiaries who reached that [proposed limit] threshold for at least one day in 2016.”
EVENTS & MEETINGS
Your March Calendar:
March 7
8:00 a.m., AHIP National Health Policy Conference, program on opioids featuring FDA Cmsr. Gottlieb, Deputy AG Rosenstein, register at https://www.ahip.org/policy-2018-registration-policies/.
March 16
11:00 a.m., AHRQ, National Advisory Council for Healthcare Research and Quality, by WebEx, information at https://www.ahrq.gov/news/events/nac/.
March 26
PTAC, Physician-Focused Payment Model Technical Advisory Committee, continuing March 27, information at www.regonline.com/PTACMeetingsRegistration or livestream at www.hhs.gov/live.
FOR REFERENCE
Members of the Senate (here) and Members of Senate Committees (here), Senate Calendar (here).
Members of the House with their House Committees (here), House Calendar (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
DCMedical News is published every day that either the House of Representatives or the Senate is in session.
March publication dates: 8, 9, 12, 13, 14, 15, 16, 19, 20, 21, 22, 23.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com