DCMedical News: Wednesday, September 30, 2020
DCMedical News-DCMN
Washington, D.C.
Wednesday, September 30, 2020
DCMedical News is published every day both the House and the Senate are scheduled to be in session this year. The next editions will be on October 1 and 2, followed by a hiatus until November 16. Subscription information and archives here.
THE BIG STORY IN HEALTH CARE
The Presidential and Other Campaign(s)
Candidates Debate: President Trump and former Vice President Biden squared off in the Sheila And Eric Samson Pavilion, a 477,000 sf education center (here) which is part of the Cleveland Clinic, in the first of three debates before the November 3 election. Health issues were on the front and middle burners, including the Coronavirus pandemic and its sequelae, and preservation of the remaining parts (see e.g. here) of the Patient Protection and Affordable Care Act.
The Kaiser Family Foundation (KFF) (here) reports that “President Trump has advocated repeal of the ACA and his administration currently supports a lawsuit that would overturn the law. If successful, the lawsuit could lead to significant coverage losses. President Trump has also expanded the availability of short-term plans, which have lower premiums than ACA-compliant plans because they do not have to follow the ACA’s rules, particularly coverage of pre-existing conditions.” In another post, KFF reports (here) on the potential loss of coverage for those (e.g. 44% of 55-64 year olds) with pre-existent conditions. The New York Post, however, reports (here) on “Eleven Things Trump Has Done to Fix Obamacare.” KFF says “Former Vice President Joe Biden, on the other hand, has supported building on the ACA framework by expanding subsidies and creating a new public option. While Biden’s public option proposal has received significant attention, his proposal to expand ACA premium subsidies has not been the subject of much public discussion or analysis, especially his plan to extend eligibility for subsidies to people with employer coverage.” The AMA explains (here) “Why it’s OK for doctors to ask their patients about voting.”
Commonwealth Fund health-related election issues polling results, charts here, story here.
Congress: Movement on a fourth coronavirus aid package is again reported. The new House $2.2 trillion (2152 pages) bill is here.
Coronavirus
Tracking: By Johns Hopkins (here) shows on 9-29 at 8:00 p.m. EST worldwide 33,489,205 confirmed COVID-19 cases; 1,004,278 deaths worldwide; 205,883 U.S. deaths (20% of the world death total).
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
RAND Issues Third Report on Payments to Hospitals
RAND reports (here) that, on average, hospitals are paid 250% of Medicare reimbursement for the same services, similar to findings in their previous report, with the highest rates (350%) in West Virginia and South Carolina. RAND list of hospitals (Excel), here. Advisory Board list of “top ten” states here. AHA responds, here and (with Nate Kaufman) here.
Hospital-in-the-Home
The Association of American Medical Colleges reports on the movement, here.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Meets Tomorrow and Friday
The Congressional Advisory Body meets to discuss, among other topics, the Medicare Advantage program (here), noting “Overall the MA program is not generating savings relative to FFS [fee-for-service, traditional Medicare] payments. In order for the program to realize savings from the efficiency of the MA program, changes to current MA payment structure may be necessary.” This as the HHS OIG reports (here) MA plans gamed “risk assessment” calculations to net an unearned $2.6 billion in 2016, Bloomberg report here notes that “CMS estimates that from 2013 through 2017, Medicare provided $50 billion in overpayments due to “plan submitted diagnoses that were not supported by beneficiaries’ medical records.” In an interview with Bloomberg, OIG said ““We feel $2.6 billion is a lot of money.”
MedPAC agenda here, transcript of September meeting here.
CBO Projects Cost of Federal Subsidy of Health Insurance 2020-2030
The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) have projected (here) the net cost of all federal subsidies for health insurance for the coming decade. “Net federal subsidies (that is, the cost of all the subsidies minus the taxes and penalties) in 2021 for insured people are $920 billion, or 4.4 percent of gross domestic product (GDP). In 2030, that annual amount is projected to reach $1.4 trillion, also 4.4 percent of GDP. Over the 2021–2030 period, subsidies are projected to total $10.8 trillion. Medicaid and the Children’s Health Insurance Program (CHIP) account for about 45 percent of the federal subsidies annually during the period; Subsidies for employment-based coverage, about 35 percent; Payments for Medicare, about 15 percent; and Subsidies for coverage obtained through the marketplaces established by the Affordable Care Act or through the Basic Health Program, about 5 percent.”
With regard to coverage, and the impact of the pandemic on health insurance, CBO says “Since CBO last issued baseline projections, in March 2020, the coronavirus pandemic has disrupted the economy, and millions of jobs have been lost. In the projections for the next few years, the loss of employment has these effects: It decreases estimated enrollment in and subsidies for employment-based insurance; It increases estimated enrollment in and subsidies for Medicaid and CHIP; and It increases, on net, the number of people estimated to be uninsured. Legislative responses to the pandemic have, among other things, temporarily increased the share of Medicaid and CHIP costs paid by the federal government, allowed Medicaid and CHIP enrollees to remain enrolled through the end of the public health emergency regardless of changes in income, and provided forgivable loans and tax credits to businesses to help them retain employees. By CBO and JCT’s estimates, those laws have increased enrollment in Medicaid, as well as the average cost of Medicaid, and lessened the decline in employment-based insurance. Compared with the March 2020 estimates, current projections show about 1 million more people uninsured in 2021, largely reflecting the effects of the pandemic.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References (alphabetical):
AMA resource page for physicians here. AMA guide to medical education and COVID-19, here.
CDC information page for professionals here, Morbidity and Mortality Weekly Reports on Coronavirus, here.
CMS (Centers for Medicare & Medicaid Services) Current Emergencies website, here.
JAMA Network’s COVID-19 resource center here.
New England Journal of Medicine update here, New England Journal of Medicine Journal Watch here.
The Lancet COVID-19 Resource Centre here and real-time dashboard to monitor clinical trials, here.
State actions, Kaiser Family Foundation, here.
UC Hastings College of Law’s “The Source” (on health care prices and competition) COVID-19 page, here.
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Committees and Members at https://www.senate.gov/committees
CQ 2020 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 1, 2
November 16, 17, 18, 19, 20
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.