WEEKLY E-BULLETIN


New Administration Moves to Stabilize Health Insurance Markets

CMS formally submitted a proposed rule to the Office of Management and Budget last week, which is focused on stabilizing the ACA markets. Details are expected to be made public this week. Limited information is available on OMB’s website, click here.

  • CMS also released proposed 2018 payment and policy updates for Medicare Advantage and Drug Plans. The net payment impact would result in an increase of 0.25 percent on average for Medicare Advantage plans. Click here for the CMS fact sheet on the proposal, and here for the 2018 Advance Notice and Draft Call Letter.  These regs were strongly endorsed by the top Health Committee chairs in the House.  Click here.

House and Senate Committees Working to Stabilize Insurance Markets

Senate and House committees are now focusing on how to stabilize the individual markets created by the Affordable Care Act. Witnesses before two committees pressed repeatedly for certainty and transparency, as soon as possible because insurers must submit their 2018 rates for review by May. In a Finance Committee hearing witnesses blamed what they described as the ACA’s heavy-handed approach toward regulating what products can be sold and what benefits must be provided. A House committee reviewed several bills that would reform insurance plans, such as increasing the variation around the age rating for ACA plans and ensure protections for patients with pre-existing conditions. Click here to view the Finance Committee hearing and testimony, and here for the Energy & Commerce hearing.

GOP Senate Leaders Considering “Repair” Strategy for ACA

Top Republican leaders in the Senate are re-thinking the GOP’s “Repeal and Replace” Obamacare strategy and are now considering a plan that would repair the problems with the current system.  While trying to provide more marketplace certainty for private insurance companies, Republicans are finding that the uncertainty created by repeal and replace rhetoric are actually causing insurers to leave the market.  Click here for the report.

ACA Enrollment Lower than Expected

About 9.2 million people signed up for Affordable Care Act plans through HealthCare.gov during the just-closed open enrollment period, according to HHS. This update does not include enrollment figures for the 11 states and the District of Columbia that operate their own health insurance exchanges. The announcement comes just days after the Trump Administration canceled millions of dollars worth of ads designed to increase the numbers before the deadline. The Obama Administration had estimated that 13.8 million people nationwide would sign up for plans during the three-month enrollment season. To read the CMS fact sheet, click here.

Aetna Will Exit ACA Exchanges in 2018; Other National Plans Still Deciding

Aetna is not planning to participate in any of the public exchanges created by the health law in 2018, CEO Mark Bertolini said on the insurance giant’s fourth quarter earnings call last week. He added Aetna would participate where necessary to support the transition to a new health insurance system, if one is put in place, however uncertainty over efforts to repeal and replace the health law is a factor in the company’s 2018 plans. To listen to a webcast of the call and review Aetna guidance and financial documents, click here.  Click here to see how other national plans are looking at the 2018 Exchange market.

Medicaid Policy Changes May Be on Their Way

House Energy and Commerce Committee is working on making changes to national Medicaid policy. The committee held a hearing last week entitled “Strengthening Medicaid and Prioritizing the Most Vulnerable” that included three draft bills that would limit who qualifies for the benefits. Republicans argue that there’s a need to restrain growth in Medicaid’s costs and focus the program’s funds on what they see as its intended population. The federal share of Medicaid spending may rise to $650 billion in fiscal 2027 from $368 billion in fiscal 2016, according to a committee memo. To view the testimony, watch the webcast, and read the Committee background memo, click here.

Price May Be Approved for HHS Secretary by Full Senate this Week

After changing Committee rules, the Senate Finance Committee Republican Members advanced the HHS nomination of Rep. Tom Price to the full Senate vote. Earlier in the week, in answers to questions for the record, Price pledged to senators he would press ahead on new Medicare payment systems, telemedicine and accountable care organizations while giving few details on how. In 136 pages of answers to questions from Finance Committee senators, Price said “significant challenges remain” with implementation of the 2015 Medicare physician payment law but did not elaborate. The final MACRA rule, he added, “took steps to address physician concerns.” Click here to view all his answers to the Committee’s questions.

“Two-for-One” Regulation Order Clarified

 President Trump issued an Executive Order last week requiring that any time an agency or department publicly proposes a new regulation, it must identify two existing regulations to be repealed. Follow up guidance clarifies that the two-for-one rule applies only to “significant” regulations, which are defined as any that that imposes an annual economic cost of $100 million or more. Click here to review the guidance.

New Studies Throw Cold Water on Doctor Pay-for-Performance Incentives

Looking to increase incentives for improving care, recent federal and private strategies have turned to a “pay-for-performance” model where physicians get bonuses for meeting certain “quality of care standards.” According to studies by the CDC and in Britain, this system simply does not work. One study of British doctors showed a $12 billion program that links doctors’ incomes to measures of health-care quality had no effect. Click here for more on these studies.

Request for MedPAC, MACPAC Nominations

The Government Accountability Office is calling for nominations for MedPAC and MACPAC Commissioners. Nominations for MedPAC are for rural providers and stakeholders with expertise on the financing and delivery of health care services in rural areas. MACPAC is accepting nominations for any healthcare professional with Medicaid expertise. Click here for the MedPAC announcement, and here for the MACPAC announcement.

340B Mega Guidance Formally Withdrawn

The Office of Management and Budget withdrew a pending regulation for the 340B drug program that would have tightened controls on which patients, drugs and providers qualify for steep discounts on prescription medicines. Click here for the announcement.

House Bill Tries To Prevent Price Increases on Old Medicines

The House Energy and Commerce Committee will consider a bill this week that seeks to increase competition for generic drugs to prevent pharmaceutical companies from jacking up the prices of old medicines. The Lower Drug Costs Through Competition Act, introduced last week by Reps. Gus Bilirakis (R-FL) and Kurt Schrader (D-OR), would incentivize drug companies to develop generic drugs amid shortages or absence of competition. Click here for an FDA Law Blog review of the legislation.

ICER Re-Evaluates Its Rx and Device Program

The Institute for Clinical and Economic Review wants to change how it evaluates the cost-effectiveness of new drugs and medical devices – these are moves that will likely ease some of the drug industry’s concerns. The independent non-profit research institute produces reports analyzing the evidence on the effectiveness of drugs and establishes cost-effective prices. They also point out when drug prices for new products may contribute to unaffordable short-term cost growth for the U.S. health system. Click here to read their recommendations.

Provider Coalition Pushes Advocacy on Health Disparities

The Root Cause Coalition, a national, provider-driven, nonprofit organization dedicated to addressing the root causes of health disparities, presented the first installment of their 2017 webinar series last week. During last week’s webinar, speakers discussed the likely policy changes around healthcare and federal assistance programs and shared the ways organizations can come together to make the most impact in their advocacy efforts. To view the slide deck and a full recording of the webinar click here.

  • The Commonwealth Care Alliance, the nation’s first social ACO, writes about its success with integrating social care into its care model.  Click here.

Heart Failure Rates in U.S. Increasing

American Heart Association data show increasing rates of heart failure in the US, and a new report notes heart disease still is the leading cause of death, even as death rates from it decrease. The report found heart failure cases are expected to increase 46% by 2030.  Click here for the report.