WEEKLY E-BULLETIN


ACA Repeal, Replace, Repair Plans Raise Serious Concerns Among GOP Leaders

Someone recorded the private session of GOP lawmakers’ retreat last week in Philadelphia and much of the discussion centered around the repeal of the Affordable Care Act.  Reports says GOP legislators appear to be concerned about a speedy Obamacare repeal and how to communicate all of it to the American people.  Click here and here for the Washington Post stories.  Officials say it was an unauthorized intruder who made the recording.  Click here.

New GOP Bills Provide Glimpse into Obamacare Replacement, Repair Plans

Republicans have introduced ACA replacement and repair plans, providing the first detailed glimpse at what may become the Republican healthcare plan.

    • Senator Cassidy, M.D. (R-LA), joined by Senators Collins (R-ME), Capito (R-WV), and Isakson (R-GA), introduced the Patient Freedom Act of 2017 (S.191). The plan would repeal the ACA’s mandates (individual, employer, age bands, essential benefits, etc.) while preserving the prohibition on annual and lifetime limits, pre-existing condition exclusions, and discrimination, etc. The legislation would require states to choose between (1) Title I of the ACA (with a cap on federal dollars at contribution levels for Option 2); (2) implementation of a new market-based system in the state that could continue to receive up to 95% of federal premium tax credits and cost-sharing subsidies and the federal Medicaid-expansion match – with funds being deposited in Roth Health Savings Accounts; (3) design an alternative solution without federal assistance. For more information, please see a one-pager and a full section-by-section analysis.
    • Senator Paul, M.D. (R-KY), an ophthalmologist and one of the most conservative members of the Senate, introduced his ACA replacement bill (S.222). The legislation would eliminate the essential health benefit requirements, provides up to a $5,000 tax credit for individuals that contribute to HSAs, eliminates the cap on annual contributions to HSAs, allows small businesses and individuals to group together to purchase insurance, allows insurance to be purchased across state lines, and authorizes greater Medicaid program flexibility through waivers. Paul’s plan does not address Medicaid expansion. An outline of Paul’s plan can be found here.

GOP Chairman to Introduce Pre-Existing Conditions Bill; Push Is On to Stabilize Insurance Markets

House Energy and Commerce Chairman Greg Walden (R-OR) said he has plans to introduce a bill this week that will require health plans to cover people with pre-existing conditions. Walden also indicated that Republicans have “always” backed a provision dealing with coverage for people up to age 26. Click here for more. The Commerce’s Health Subcommittee will hold a hearing Feb. 2nd on a legislative package that aligns with the insurance industry’s proposals to shore up the struggling exchanges. The legislative package would loosen age-rating bands, ensure patients with preexisting conditions are not denied coverage, require pre-enrollment verification for special enrollment periods and reduce the ACA’s 90-day grace period. To see the hearing information and the draft legislation, click here.

Price Likely to be Approved by Finance Committee This Week; Governors Speak Out on Costs

HHS nominee Tom Price faced the Senate Finance Committee offered broad goals for replacement and further defended his stock investments. View the hearing in its entirety here.  Price said the replacement should take care of individuals with pre-existing conditions and continue coverage for preventive care. And he said that efforts to replace the law should be made “simultaneously” with its undoing, so that coverage isn’t disrupted. Click here for more.

  • The National Governors Association said in a letter to House Republicans that it is “critical” that Congress doesn’t shift more costs onto states. The bipartisan letter didn’t specifically name Medicaid block grants or per capita caps, but it stressed that providing health care to vulnerable populations “is a shared responsibility between the federal government and the states.” Read the letter here.  Some GOP governors are fighting to keep their Medicaid expansions.  Click here for that report.

Payment Reform Goals Outlines in Letter to President

Some of the nation’s leading health care advocacy organizations that support the shift to value-based payments sent a letter Jan. 25th to the White House outlining their principles for the health care system. Their 10 recommendations include expanding waivers to promote collaboration, increasing access to claims data sets, and aligning public- and private-payer programs. To read the letter, click here.

HHS OK’s Free Patient Rides to Appointments

An HHS Office of Inspector General final rule that will exempt free rides from health care anti-kickback statutes is expected to dramatically increase the growth of on-demand ride sharing for patients. The rule, finalized in December, clarifies that hospitals and clinics can offer free rides to patients without violating the anti-kickback statute. The hope is that by providing transportation services such as Uber and Lyft rides, providers will be able to cut down on missed appointments, eliminate unnecessary hospitalizations and reduce overall health care spending. Lyft is already partnering with Ascension, the country’s largest nonprofit hospital system, to provide rides to patients. Among the hospitals working with Uber: New Jersey’s Hackensack UMC and Florida’s Sarasota Memorial. To read the final rule, click here.

Effort Underway to Exempt VA Care Providers from Hiring Freeze

The Chairmen of House and Senate Veterans’ Affairs Committees are pressing President Trump to permit the VA to exempt “direct patient care providers” from the new federal hiring freeze. For the GOP Chairmen letter, click here. For the Ranking Democrat letter, click here. Acting Veterans Affairs Secretary Robert Snyder on Friday issued a memo exempting a series of VA positions, mostly related to the delivery of medical services, from a new government-wide hiring freeze, citing public safety concerns. Click here for the memo.

Heroin Overdose Antidote Has Hefty Price Tag

A privately-held pharmaceutical firm, Kaleo, has an antidote for the opioid epidemic — but its fast-rising price is putting it out of reach — it’s a $4,500 injection to stop heroin overdoses.  Click here for the story.

Medicaid Babies Have Much Higher Mortality Risk: CDC

CDC researchers found that infants born at term with birth defects who were covered by Medicaid had a 45% increased mortality risk regardless of birth defect type, compared with those who were covered by private insurance. The findings are based on 2011 to 2013 payment data involving more than 9.5 million deliveries in more than 30 states and D.C., should prompt efforts to bolster care access and quality to curb birth defect deaths for all deliveries, researchers said. Click here for the CDC report.

Groups Want Fix for Home Infusion Coverage Gap

More than 170 physicians and physician groups, patient advocacy groups, hospitals and medical associations sent a letter to Congressional leaders requesting swift change to provisions of the 21st Century Cures Act that they say created a reimbursement gap for Medicare Part B durable medical equipment drugs for vulnerable patients with home infusion therapy. The Cures law put in place an average sales price pay formula for Part B DME infusion drugs starting this month, but the law delayed until January of 2021 a payment system for home services associated with the infusions. The groups wrote that any change in Part B DME drug reimbursement should be implemented simultaneously with payment for home infusion services. Click here for the letter.

Physician Survey Shows Broad Opposition to Full ACA Repeal

A new survey of doctors shows overwhelming opposition to the effort by Republicans to repeal the Affordable Care Act . The results, published in JAMA, show 15 percent of the 426 primary care physicians in the survey favor total repeal, and among doctors who voted for Trump, 38 percent said they wanted the act eliminated in its entirety. A repair plan would have more favorability – 74 percent favored making improvements to the ACA. To read the full report, click here.

AMA Pushes for Changes to Prior Authorization Policies

The American Medical Association is calling for changes to policies insurers use to require patients to seek prior authorization before they can access certain procedures and prescription drugs. The nation’s largest physicians’ group warns that care is often delayed while permission is sought. The AMA, in conjunction with 16 other health care groups, has created a list of 21 principles that it believes should be incorporated into prior authorization policies in the future. Click here for more from the AMA.

45 Percent of MA Provider Directory Entries Inaccurate: CMS

CMS says it found that about 45 percent of Medicare Advantage provider directory entries were inaccurate after reviewing a third of MA plan directories. CMS states that poor directories are widespread among plans and “call into question the adequacy and validity” of plan networks. While CMS said that the percent of inaccuracies ranged across plans, the majority of Medicare Advantage plans had entries that were inaccurate between 30 and 60 percent of the time. To read the report, click here.

CBO Slashes Marketplace Enrollment Projections

The Congressional Budget Office has lowered its previous projections for enrollment in the ACA marketplaces, but maintained that the individual insurance market remains on a steady trajectory. CBO predicts that about 10 million people will get health insurance through the marketplaces in 2017, down from an earlier projection of 15 million. CBO also revised the number of people expected to buy health insurance through the marketplaces in 2027 – down from between 18 and 19 million in last year’s projection to 13 million. Click here for the report.

Aetna-Humana Merger Blocked by Judge

A federal judge sided with the Justice Department last week and blocked the $37 billion merger between health insurers Aetna Inc. and Humana Inc. over concerns the deal would harm industry competition and lead to higher prices for senior citizens. Together, the two companies cover 4.5 million of the nearly 17 million seniors enrolled in MA plans. It’s unclear if the Justice Department under the new Administration will take a friendlier view of the merger. Aetna is already saying it is considering appealing. Click here for the judgment.