DCMedical News: Wednesday, December 11, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, December 11, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Congressional End-of-Session Chaos
The next appropriations fiscal cliff (authorization to spend money runs out for the federal government, leading to a “government shutdown”) is December 20. The pending deadline is an opportunity for the passage of “surprise” bills unrelated to appropriations per se, including measures in the health field.
STAT reports that “House and Senate staff were working all weekend to hammer out a funding agreement before another massive shutdown could begin on Dec. 20.”
Just so for tax law, as well, as Bloomberg reports: “Health care staffers are considering trying to repeal or further delay Affordable Care Act taxes” including the “40% tax on high-value health insurance plans known as the ‘Cadillac tax,’ which is set to take effect in 2022 after delays,” and “delaying or repealing of the 2.3% medical device tax and a sales tax on health insurance.”
The White House announced support (here) for the “surprise medical bill” package negotiated by Senator Alexander and House leaders from both parties. "Americans should not be surprised with huge medical bills when they are most vulnerable. We are hopeful Congress will focus on this important issue and act this year and send legislation to the President to sign into law."
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Traditional Medicare May Add $358bn in Benefits
See story below under Medicare and the potential for additional dental, vision, hearing benefits to be tacked on to a drug price control bill. Writes CQ, “Medicare currently only covers certain dental and hearing services under extreme circumstances — such as inpatient dental procedures or cochlear implants — and nothing related to eye exams for glasses or contacts.” The trade group for Medicare Advantage plans, “suggested that it would be unnecessary to expand benefits and noted that nearly all beneficiaries could join private plans with additional benefits.” But the “National Association of Dental Plans, the National Association of Vision Care Plans, the American Council of Life Insurers, the International Hearing Society and the American Optometric Association, endorse the idea.”
For dentists, the bill would cover 80% of basic services, 50% of crowns and root canals, for example. Dental associations, like doctors, opposed Medicare’s passage in 1965, concerned that government payment rates would be inadequate; a 2017 study by the American Dental Association (here) shows Medicaid rates to be 37% of private pay rates for dentists.
Physicians Continue to Become Hospital Employees
Crain’s Chicago Business reports on an updated Avalere Health/Physicians Advocacy Institute study (here) on physicians leaving private practice for hospital employment. Highlights: “The trend of physicians leaving private practice and entering into hospital employment showed consistent growth from 2016 to 2018, according to the data from Avalere Health and the Physicians Advocacy Institute in an updated physician practice acquisition study.”
“Nationally, 44 percent of doctors were employed by hospitals as of January 2018. Regionally, the study showed the Midwest leads the pack in the percentage of hospital-employed doctors. Fifty-five percent of physicians in the Midwest were employed by hospitals in January 2018, up from 34 percent in July 2012, the study said.”
Tomorrow’s Doctors Profiled in AAMC Annual Summary of 2019 Applicants and Matriculants to Medical School
The summary (here) has links in pdf and Excel to detail. In a statement (here) the Association of American Medical Colleges wrote “For the first time ever, the majority of U.S. medical school students are women, marking another milestone in the gradual diversification of those studying to become America’s next generation of physicians.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
CBO Reports on House Drug Price/Medicare Expansion Bill, Now Named the Elijah Cummings Bill
CBO reports (here) that “CBO and JCT estimate that enacting the current version of H.R. 3 would increase direct spending by about $40 billion and increase revenues by about $46 billion over the 2020-2029 period. The largest effects on spending over that period would result from . . . price negotiation provisions [which] would lower spending by about $456 billion, and the provisions providing dental, vision, and hearing coverage under the Medicare program would raise spending by approximately $358 billion.” CBO cautions that “The estimates are uncertain. For example, the price negotiation process could be implemented in ways that differ from CBO’s interpretation, and manufacturers might respond to it differently from what CBO has projected.”
The proposed new “traditional Medicare” benefits patched on to the drug bill would be a boon for the 65% of Medicare beneficiaries not enrolled in Medicare Advantage (MA) plans. But they would also pose a significant threat to the MA plans which use their flexibility to offer vision and dental care as lures for traditional Medicare beneficiaries. A new study from Duke (here) casts doubt on whether the MA plans have an appetite to offer more robust and expensive benefits which are newly authorized for 2020, including home-based palliative care, in-home support services and support for caregivers.
The Hill reports that Speaker Pelosi and “progressives” have reached an arrangement under which the latter would support the H.R. 3. “Those changes are to increase the minimum number of drugs subject to negotiation under the bill from 35 to 50 and to restore the implementation of [Rep. Pramila] Jayapal’s amendment, which would extend protections against drug price spikes to people on employer-sponsored health insurance plans, not just those on Medicare.”
DRUGS AND DEVICES
STAT Finds Innovation Lacking in Large Drug Companies
STAT reports (here) that “Large pharmaceutical companies did not actually invent most of the drugs they sell. Indeed, it appears they have already reduced their investment in the discovery of new medicines to the point where the threat of additional reductions rings hollow and is no longer a persuasive reason for opposing legislation to lower drug prices.” The study focused on Pfizer and Johnson & Johnson: “The 34 Pfizer products discovered by third parties accounted for 86% of the $37.6 billion in revenue that its 44 leading products generated. The 16 J&J products invented elsewhere accounted for 89% of the $31.4 billion that its 18 leading products generated.”
READINGS AND REFERENCES
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
House 2020 Calendar of Regularly Scheduled Sessions, here; Senate schedule subject to Impeachment Debate
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
December 12
January 7, 8, 9, 10, 13, 14, 15, 16, 27, 28
February 4, 5, 6, 7, 10, 11, 12, 13, 25, 26, 27, 28
March 2, 3, 4, 5, 9, 10, 11, 12, 23, 24, 25, 26, 27, 30, 31
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.