DCMedical News: Wednesday, January 9, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, January 9, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
THE BIG STORY IN HEALTH CARE:
Health Impact of the Government Shutdown: Various federal agencies, think tanks and legislators are compiling the “health cost” of the partial federal government shutdown which began December 22. Among the issues:
Medicare: CQ reported Tuesday a sequestration impact beginning in February. The “pay-as-you-go” balance left from 2018 would necessitate $839 million in sequestration from nonexempt federal programs, of which $753 million would come from Medicare. Later in the day, OMB reported that the cutbacks would not take place in Medicare, pending resolution of the shutdown and recalculation of the amounts (if any) to be sequestered.
Social Services: Authorization for the Temporary Assistance to Needy Families (3.5 million people) expired December 21.
Agriculture: Legislators have inquired of USDA Secretary Sonny Perdue what would happen to the 38 million beneficiaries of the food stamp program [Supplemental Nutrition Assistance Program, SNAP, formerly “food stamps”] after the end of the month if the shutdown continues. They noted that the USDA received $3 billion worth of reserve funding for SNAP in the 2018 budget bill, but estimations based on program participation suggest this amount would fail to provide all recipients with full benefits for the month of February, and no benefits beyond that month. The average household income for those receiving SNAP assistance was $813 a month in 2016, with an average SNAP benefit per household of $249 a month. House Members noted that the cost of SNAP is too large for states to take over, even temporarily. Center for Budget and Policy Priorities analysis of SNAP shortfalls in the shutdown here. Also imperiled: federal funds for the WIC (Women, Infants and Children) food programs, for which resources were exhausted in December, as well as school breakfast and lunch programs.
Health Insurance, Litigation: The Hill reports that “The Department of Justice (DOJ) is asking a federal judge to pause all briefings related to a motion filed by House Democrats in an ongoing ObamaCare lawsuit, saying they cannot complete their work properly due to the government shutdown.”
General: Many of the 800,000 furloughed or working-but-unpaid employees miss their first paycheck January 11. The U.S. Chamber of Commerce has noted extensive damage to the economy.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Thumb on the ACO Scale: Modern Healthcare reports that “Medicare accountable care organizations accepting downside financial risk will have easier access to CMS waivers of the rule requiring three-day inpatient stays before patients can be sent to skilled nursing facilities.” The CMS “guidance” (here) follows on findings (e.g. Leavitt-Duke study here) that ACOs which were successful in cost saving spent more on doctors, less on inpatient and skilled nursing care. HFM on the new rule (risk assumption by risk-averse ACOs) here.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Readmissions Reduction, or Readmissions Re-Measurement: A study in Health Affairs (here, Dafny, Grabowski, Cutler and others, reported in Modern Healthcare, here) casts doubt on the measurement of actual hospital readmissions, on grounds that CMS has allowed coding changes which obscure the actual results (reduction of readmissions). This in addition to recent studies and reports on the unfavorable impact of readmission reduction efforts on patients (here, here and here).
California Takes on National Role in Health Insurance, Health Policy and Drug Prices: In his first Executive Order (here), newly inaugurated Governor Gavin Newsom proposed “California Health Care for All.” The program includes expanding subsidies for health insurance to those having incomes between 400 and 600 per cent of the federal poverty level; creating the position of California Surgeon General; and proposed single purchasing power for the State in its contracts for drugs, an effort which would make California the single largest purchaser of drugs in the nation. “The negotiation for pricing and purchasing of prescription drugs under Medi-Cal will now be conducted by the Department of Health Care Services on behalf of all 13 million Medi-Cal beneficiaries, as opposed to only 2 million currently. Further, the executive order directs state agencies to purchase prescription drugs together, as opposed to negotiating with drug companies one by one; and charts the path to enable all Californians, including private purchasers, to join forces with public purchasers.”
Washington’s Public Option: The other Washington (the state) proposed a public option for health insurance (here). According to Governor Inslee’s news release, “The Health Care Authority will contract with one or more health carriers to offer qualified health plans on the Exchange. Beginning in 2021, all carriers offering plans inside the Exchange must offer a standard plan at any tier in which they offer at least one plan. Non-standard plans may be offered on the exchange through 2024. Beginning in 2025 only standard plans will be offered on the Exchange.”
NYC to Expand Health Coverage Through H+HC: In New York City, Mayor Bill de Blasio today announced (here)that his “administration will launch the largest, most comprehensive plan in the nation to guarantee health care for every New Yorker. The plan will serve the 600,000 New Yorkers without insurance by strengthening NYC’s public health insurance option, MetroPlus, and guaranteeing anyone ineligible for insurance – including undocumented New Yorkers – has direct access to NYC Health + Hospitals’ physicians, pharmacies and mental health and substance abuse services through a new program called NYC Care. All services will be affordable on a sliding scale.”
DRUGS AND DEVICES
JPMorgan in San Francisco: The annual conference on finance, drugs, services and devices in health care is on. CEO of CVS-Aetna (transcript here) at JPM/SF on the new company.
READINGS & 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.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
Publication dates are the regularly scheduled days the House or the Senate is in session.
Remaining January publication dates: 10, 11, 14, 15, 16, 17, 18, 28, 29, 30, 31
February publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28
March publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.