WEEKLY E-BULLETIN


The Repeal of the Affordable Care Act – A Perspective

The GOP controlled Congress is just weeks away from repealing the Affordable Care Act.  The House followed the Senate late last week and passed legislation that puts the end of Obamacare in sight.  What does this really mean for health care providers?  Will more than 20 million Americans lose their insurance coverage?  Well, the congressional fight appears to be mostly a pitched partisan battle.  The ACA passed in 2010 with only Democratic votes.  Now, almost seven years later, Republicans may return the favor with repeal.  Hospitals and physicians should be careful not to get caught up in the partisanship.  So far, not a single vote has cut coverage for anyone.

GOP leaders are already publicly talking about preserving coverage for everyone covered by an Affordable Care Act program today – but, perhaps by different means.  Many GOP governors whose states expanded Medicaid are urging their Republican colleagues in Congress not to repeal Medicaid expansion.  Congressional leaders have been in discussions with major insurers about stabilizing the insurance markets across the country.  President-elect Trump said his administration will actively engage in all these issues once his HHS Secretary is confirmed: U.S. Rep.Tom Price, M.D.  He’s a very conservative orthopedic surgeon by training who has been in Congress since 2005.  Our firm has worked with him on many issues and we know him to be genuinely concerned with assuring that Americans get the health care they need.

And that’s the fight we should actively join – the battle to ensure that as many Americans as possible have the coverage and access they need.  Should we care what it is called?  Obamacare, Trumpcare…?

  • Click here for the NYTimes story about the House vote to repeal the ACA.
  • Click here for the story on Congress’ next steps to replace Obamacare.
  • Click here for a report on the timing of when changes would impact consumers.
  • Click here for a good report on the ACA’s biggest provisions and what the GOP may do to replace them.

The GOP governors of AR, FL, ID, IA, MI, OH, SD, TX, and UT are planning to attend a closed-door roundtable meeting of the Republican members of the Senate Finance Committee this Thursday afternoon in Washington to discuss the future of Medicaid.  Click here for the letter the committee sent to governors last month.

Senior Save More than $5.6 Billion in Rx Costs Last Year

HHS last week released new information that shows that more than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary – since the enactment of the Affordable Care Act. In 2016 alone, over 4.9 million seniors and people with disabilities received discounts of over $5.6 billion, for an average of $1,149 per beneficiary.  Click here for details.

  • AbbVie Rx company announced it will keep drug prices to below 10 percent.  Click here.

Underpricing To Blame for Obamacare Premium Spikes This Year: Study

Big premium increases for Obamacare plans in 2017 — upwards of 20 percent on average nationwide — are primarily due to underpricing during the first two years of exchange operations, according to a report released last week by researchers at the Urban Institute. There were big differences in 2017 premium increases nationwide. While three states saw monthly costs for the cheapest silver plan spike by upwards of 50 percent, including 125 percent in Arizona, five states actually saw decreases. Overall, one in ten Americans live in areas where the premium for the cheapest silver plan decreased this year. Click here for the analysis.

CMS Launches Rural Hospital Global Budget Model in Pennsylvania

CMS and Pennsylvania announced the Pennsylvania Rural Health Model last week.  Under this model, participating rural hospitals will receive all-payer global budgets—or a fixed amount of money that is set in advance and funded by all participating payers—to cover the inpatient and outpatient services they provide. Rural hospitals will use this predictable funding to deliberately redesign the care they deliver to improve quality and meet the health needs of their local communities. The Model is open to critical access hospitals and acute care hospitals in rural Pennsylvania. In addition, other payers covering individuals in the Commonwealth, including Medicaid and commercial health plans, are eligible to participate in the model by paying participating rural hospitals through global budgets.  Click here for details.

Rural Americans Have Higher Death Rates than Those in Urban Areas: CDC

Americans living in rural areas have higher death rates and suffer more preventable deaths from the leading causes of mortality compared to people in urban areas, according to a new CDC report.  Mortality rates for the leading causes of death — heart disease, stroke, cancer, unintentional injury and chronic lower respiratory disease — were all higher among people living in rural areas compared to people living in metropolitan areas between 1999 and 2014.  Click here for the report.

CMS Issues Final Home Health CoP Rules

CMS last week finalized rules governing home health agencies that are designed improve the quality of health care services for Medicare and Medicaid patients and strengthen patients’ rights. These Medicare and Medicaid Conditions of Participation are the minimum health and safety standards a home health agency must meet in order to participate in the Medicare and Medicaid programs.  Click here for a summary and to read the rules.

New Mental Health Regs Allow for Greater Patient Record Sharing

HHS’s mental health agency on Friday issued a final rule that eases sharing of substance abuse treatment records among providers and restores researchers’ access to CMS data on the disorders. The Substance Abuse and Mental Health Service Administration’s final rule lifts an old restriction that prevented certain data on substance abuse in Medicare and Medicaid from being accessed for research purposes. The rule also allows easier sharing of substance abuse treatment records among providers, while maintaining protections required under HIPAA for other medical records.  Under current law, providers have to get approval from patients each time substance abuse-related information is shared. Click here for the rule.

CMS Proposes New Prosthetics Standards

CMS has proposed a new regulation that would set specific accreditation requirements and restrict Medicare payments on prosthetics claims – Medicare would only pay claims for work completed by qualified specialists using prosthetics provided by a qualified supplier. CMS is accepting public comments on the proposed rule until March 13, 2017.  Only qualified practitioners who furnish or fabricate prosthetics and custom-fabricated orthotics and qualified suppliers who fabricate and/or bill for prosthetics would be subject to the proposed requirements.  Click here for the Strategic Health Care policy team summary.

More than 20 Percent of ED Patients Treated Out-of-Network

Patients treated in emergency departments (ED) are often cared for by out-of-network doctors, hindering efforts to stop surprise medical bills, according to research published last week in the New England Journal of Medicine The nationwide study of 2.2 million ED visits found that 22 percent of patients who went to in-network hospitals in 2014 and 2015 were treated by out-of-network doctors. The researchers estimated when out-of-network doctors billed commercial insurance for emergency services, they charged 798 percent of Medicare rates on average, versus 297 percent of Medicare rates charged by in-network physicians. Click here to view the study.

Teen Birth Rate Continues to Fall: CDC

According to a new report out from the CDC’s National Center for Health Statistics, the teen birth rate has had an unprecedented decline since 2007. The biggest declines are in large urban counties and the smallest declines in rural counties. The states with the largest drop were Arizona, Massachusetts, Connecticut, Minnesota, and Colorado, all seeing a drop of 50 percent or more. Click here for more from the CDC.

CMS Releases Dashboards Showing Drug Pricing Trends

CMS released data on Medicaid and Medicare costs last week which showed that 20 drugs saw their unit costs more than double for Medicaid in 2015. Drugs with high year-over-year price increases included both brands and generics. Nine of the 20 drugs with the highest per unit costs were generic drugs including the antimalarial treatment hydroxycholoroquine sulfate, which rose by 489 percent. Click here for more on the Medicaid Dashboard, and here for the Medicare Dashboard.

Republicans Urge Administration to Halt All Regulations

Last week, House Republican Leadership sent letters to all federal agencies requesting they halt movement on regulations until the Trump administration takes office in January. The Congressmen state that they will use their power under the Congressional Review Act to make sure the current administration heeds the request. To read the letter, click here.

FDC to Enforce Homeopathic Drugs Marketing Standards

The Federal Trade Commission issued a new enforcement policy statement on marketing claims for over-the-counter homeopathic drugs. The statement says the FTC holds the efficacy and safety claims for homeopathic drugs to the same standards as similar claims for non-homeopathic drugs. For the full memo from the FTC, click here.

ACA Fines on Employers Expected to Climb this Year

Employers are anticipated to pay $31 billion in penalties stemming from the Affordable Care Act’s employer mandate this year, according to a new report. That’s approximately 50 percent more than the original estimate by the Congressional Budget Office, and is nearly triple the amount of fines in 2015. Click here for the report.

One in Seven Will Develop a Substance Use Disorder: Surgeon General

In a report that marks the first time a U.S. surgeon general has dedicated a report to substance abuse, U.S. Surgeon General Vivek Murthy, MD, provides an in-depth look at the science of substance use disorders and addiction. The report calls for a cultural shift in the way Americans talk about the issue and recommends actions that could prevent these conditions and promote recovery. According to the report, one in seven people in the United States is expected to develop a substance use disorder at some point in their lives, yet only one in 10 receives treatment. Click here to read the report.