DCMedical News: Wednesday, May 8, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, May 8, 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
Pre-Existing Conditions:
The Office of Management and Budget issued a statement (here) on HR 986, the proposed Protecting Americans with Preexisting Conditions Act (see also DCMN 5-7-2019). The bill, poised for passage in the House, would nullify an attempt by the Administration to use §1332 (of the Patient Protection and Affordable Care Act, PPACA) waiver applications to, in fact, promote health insurance plans which (according to its Democratic sponsors) would not provide such protection. Said OMB, “The President has repeatedly made clear that this Administration will protect people with pre-existing conditions. The 2018 guidance in no way alters the guardrails in place for those with pre-existing conditions, and it would not allow the Administration to waive the requirements in place around pre-existing conditions. The title of this legislation gives the misleading impression that it will enhance healthcare protections for Americans with pre-existing conditions.” The Republican minority on the Energy and Commerce Committee didn’t like it, either (here), nor did CMS Administrator Verma, whose letter (here) is the best summary of the underlying issues.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
EMTALA Update:
Mitchell Katz (NYC Health + Hospitals CEO) writes in JAMA Internal Medicine (here) that EMTALA (the Emergency Medical Treatment and Active Labor Act) is a “noble policy that needs improvement.” Elsewhere in the journal (here) a study examines how well EMTALA ensures that patients are appropriately stabilized prior to transfer. Dr. Katz discusses the complexities of transfer, and of course the fundamental problem that “no funding is associated with EMTALA.” A four-page statute when passed in 1986, EMTALA now has several hundred pages of regulations, as well as a history of investigations, charges and the like.
Pricing News:
A report in Forbes (here) on ambulatory surgery centers indicates that they may have an easier road to take in meeting consumer expectations concerning price transparency. The industry may be ahead of hospitals in moving to publish prices that take into account specific services and insurance coverage and benefits. Also relevant, a 2018 report by the Federal Reserve (here, Report on the Economic Well-Being of U.S. Households in 2017) indicates that 40% of American adults would not be able to cover a $400 emergency expense. The answer? Payment plans.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicare’s Lower Spending in MA Plans - - Managed Care Tools or Patient Characteristics?
Kaiser Family Foundation publishes (here) a study of whether people who sign up for Medicare Advantage plans have lower Medicare spending, and why. The lower spending ($1,253 per year) included those with diabetes, asthma and prostate cancer. The study found that “Even after risk adjustment…beneficiaries who choose Medicare Advantage have lower Medicare spending – before they enroll in Medicare Advantage plans…” This is another in a long line of studies “suggesting that basing payments to plans on the spending of those in traditional Medicare may systematically overestimate expected costs of Medicare Advantage enrollees,” and of course result in overpayment to Medicare Advantage HMOs and PPOs.
Work and Health:
The Pew Foundation reports (here) on “roadblocks” to work requirements in Medicaid programs. The report says, “Toward the end of 2018, the Trump administration seemed to be marching briskly toward its goal of requiring able-bodied adults in Medicaid to prove they had jobs [in order] to participate in the public health plan for the poor.” Three “red” states that might have been expected to adopt work requirements failed to pass such legislation, some gubernatorial seats changed hands, a federal judge in Washington ruled that the administration had improperly approved work requirements for Arkansas and Kentucky and is now considering similar challenges to HHS approval of the New Hampshire plan. Other legislatures took notice and adopted narrow provisions. A spokesman for the National Health Law Program, which brought the law suit, said “It’s not surprising that a state would not want to spend a lot of money setting up a program that may be struck down by a court.”
More Work, Less Medicaid:
CMS has issued a Final Rule (here) to disallow the making of Medicaid payments directly to third parties made on behalf of an individual provider for benefits such as health insurance, skills training or other “benefits customary for employees,” a blow to the Service Employees International Union and others who had been paid directly from state Medicaid funds for the provision of such benefits
PPACA Update:
Comment has closed on the federal funding methodology for the “Basic Health Program” of the Patient Protection and Affordable Care Act for 2019 and 2020 (here). The new means of calculating funding methodology will reduce assistance to New York and Minnesota, most of it to New York.
DRUGS & DEVICES
STAT reports (here) that the utility of new and expensive cancer drugs may be less than anticipated, on grounds that clinical approvals for those drugs were obtained through randomized clinical trials in which the investigated agent was compared to “straw men,” that is, to outdated practices or those rarely or never used. JAMA Oncology finds (here) that new anti-cancer drug approvals “are reaching the market without proven superiority to what is considered the standard of care at the time of patient enrollment in pivotal trials.” A table is provided indicating the 17% of all drugs tested which had been compared to results from inferior methods.
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.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
May publication dates: 9, 10, 14 15, 16, 17, 20, 21, 22, 23
June publication dates: 5, 6, 7, 8, 11, 12, 13, 14, 25, 26, 27, 28
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.