DCMedical News: Friday, June 21, 2019
DCMedical News-DCMN
Washington, D.C.
Friday, June 21, 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
Trump Re-Election Kick-Off, Health Issues
President Trump began his 2020 re-election campaign in Orlando, FL, noting (according to Becker’s Hospital Review) these health issues: He promised to protect people with preexisting conditions. “We will always protect patients with preexisting conditions, always.”
He vowed to find a cure for cancer. “We will come up with the cures to many, many problems,” President Trump said, according to STAT. "Many, many diseases — including cancer." . . . President Trump earmarked $500 million for pediatric cancer research in the 2019 State of the Union address, but he has also reduced funding for the National Cancer Institute by $900 million, STAT reported.
He highlighted veterans' healthcare. “We passed VA Choice,” President Trump said, according to The Hill. The report notes former President Barack Obama passed the Veterans Choice Act in 2014 to allow veterans to seek care from private providers, as a response to the VA wait-time scandal. President Trump passed the VA Mission Act, which expanded private care options. ‘You go out now, you get a doctor, you fix yourself up, the doctor sends us the bill, we pay for it. And you know what? It doesn't matter because the life and the veteran is more important, but we also happen to save a lot of money doing that,’ he said.”
A C-span transcript of the President’s remarks reads “So, every time you don't have to make out a check in order not to have health care, think of that. Think of that. This is the only country, you pay for the very distinct privilege of not having to pay. But you had to pay a lot. Now you don't have to pay any more. You don't want it, you don't have to take it.” See https://www.c-span.org/video/?461325-1/president-trump-launches-election-bid-orlando-rally&live&vod
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
HRAs to be Available for Commercial (Non-PPACA Compliant) Health Insurance
The Wall Street Journal reports (here) that “The Trump administration will let employees use special pretax health arrangements to buy insurance, including policies that don’t comply with many of the Affordable Care Act’s consumer protections. The final rule issued Thursday [here] loosens restrictions on plans known as health reimbursement arrangements, or HRAs, which are funded by employers with pretax dollars. Employees use these vehicles to pay for medical expenses, but many workers have been unable to use HRAs to pay individual insurance premiums. Employees will now be able to use them to buy individual coverage, with certain restrictions, starting in January 2020. And some workers will be able to use HRAs for non-ACA-compliant plans, which offer limited benefits and exclude coverage of most pre-existing conditions.”
The proposed rule was published October 29, 2018. “The Departments received over 500 comments in response to the proposed rules from a range of stakeholders, including employers, health insurance issuers, State Exchanges, state regulators, unions, and individuals. No requests for a public hearing were received.” In response to the adverse selection issue, the final rule commentary says “The Departments acknowledge the concerns expressed by commenters that
allowing individual coverage HRAs could cause adverse selection in the individual market. As explained in the preamble to the proposed rules, allowing individual coverage HRAs could theoretically result in opportunities for employers to encourage higher-risk employees (that is, employees with high expected medical claims or employees with family members with high expected medical claims) to obtain coverage in the individual market, external to the traditional group health plan sponsored by the employer, in order to reduce the cost of traditional group health plan coverage provided by the employer to lower-risk employees.”
The final rules “allow integrating HRAs and other account-based group health plans with individual health insurance coverage or Medicare, if certain conditions are satisfied (an individual coverage HRA).” The rule is one result of the October 2017 Executive Order (here) which stated that the “Administration will prioritize three areas for improvement in the near term: association health plans (AHPs), short term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).’’ The White House announcement of the final rule is here.
MedPAC Reports to Congress
The Medicare Payment Advisory Commission June report (report here, “fact sheet” here, news release here, MedPageToday report here, AHA News report here) has been submitted to Congress. In its introduction to the 500+pages, the Commission writes: “The Commission’s June 2019 report examines a variety of Medicare payment system issues. In the 12 chapters of this report, we consider: beneficiary enrollment in Medicare: eligibility notification, enrollment process, and Part B late-enrollment penalties; restructuring Medicare Part D for the era of specialty drugs; Medicare payment strategies to improve price competition and value for Part B drugs; a mandated report on clinician payment in Medicare; issues in Medicare beneficiaries’ access to primary care; assessing the Medicare Shared Savings Program’s effect on Medicare spending; ensuring the accuracy and completeness of Medicare Advantage encounter data; redesigning the Medicare Advantage quality bonus program; payment issues in post-acute care; a mandated report on changes in post-acute and hospice care after implementation of the long-term care hospital dual payment-rate structure; options for slowing the growth of Medicare fee-for-service spending for emergency department services; and promoting integration in dual-eligible special needs plans.”
READINGS AND REFERENCES
Now They Ask
From JAMA, “Are Teaching Hospitals Worth It?,” Frakt and others (here), a double negative, “On balance, for Medicare beneficiaries, the narrative that AMCs fail to deliver sufficient value is uncertain.”
Also from JAMA, from the Dean of the Dell Medical School University of Texas, Austin, “Academic Medical Centers, Too Large for Their Own Health?”, here. “Shifting to more closely realign the incentives of AMCs with society will not be easy. The clinical enterprises have become analogous to gigantic tankers, creating momentum to continue on the current course. Lobbying for additional funding from the NIH or for more governmental support has not made research and education self-sustaining missions, and downsizing these activities could ultimately result in a slowing of health innovations and a shortage of physicians. It is also why support for ‘Medicare for All’ is not likely to come from the leadership of AMCs unless it were accompanied by a substantial change in how hospitals would be reimbursed because hospital revenues could decline substantially if reimbursement for hospitals were similar to current Medicare rates.”
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
June publication dates: 24, 25, 26, 27
July publication dates: 9, 10, 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.