August 19, 2019

Public Charge Rule: Fewer Health Care Benefits for Legal Immigrants; Lawsuits Filed
The Trump Administration has moved to reframe green card requirements through the public charge rule, stressing English language skills and wealth in order to attract immigrants who will be more self-sufficient. This rule will take away any pathway to citizenship for less wealthy, less skilled immigrants. This is expected to adversely affect healthcare spending, as immigrants will not claim benefits such as Medicare, leading to higher percentages of uninsured patients. Click here for the report from the Washington Post.  The regulations published this month do not go quite as far as those that were proposed last fall. They exclude from the definition of public charge the use of Medicaid by immigrants under the age of 21 or by pregnant women up to 60 days post-partum. The final rule also removes Medicare Part D subsidies from the definition of public charge and clarifies that benefits used by individuals while they are in an exempt status, such as being a refugee, will not be held against them if their visa status changes. The final rule also follows the proposal in excluding CHIP and state-funded benefits from the definition of public charge. Click here for further details. Several groups have already filed lawsuits to stop the rule. Click here.

Hospital Ranking Groups Under Fire
The New England Journal of Medicine released rankings of the hospital rating systems, from CMS to US News. The hospital ranking systems were rated on an alpha scale with the highest hitting a B and the lowest a D+. US News topped the list for its comprehensive rating system and methodology, whereas Healthgrades ranked last. The ratings systems have been quick to respond, arguing the results and slamming NEJM for biased and poor methodology of its own. To see the report click here. For more details, including reactions from the groups, click here.
  • CMS announced it will now require exchanges to display their five star ranking for customers. Every plan will be given a ranking from one star at the lowest to five stars at the highest based on three categories: Medical Care, Member Experience and Plan Administration. CMS hopes that this will help patients make more informed decisions before buying a plan. Click here for details from CMS.
Large Employers Alarmed Over Health Care Costs
Healthcare costs for families with coverage from large employers have risen from an average of $4,617 to $7,726 in the last decade – over 67%, according to a new report from Kaiser. This is largely due to increasing out-of-pocket costs and premiums. This is a cause of concern for families, as out-of-pocket costs continue to rise at faster average rates than wages. For the full report, click here.
  • According to the 2020 Large Employers’ Health Care Strategy and Plan Design Survey, healthcare costs are projected to rise five percent in 2020, similar to the rate that it rose in 2019. In order to curb these rising costs, employers are considering more cost management initiatives for 2020 and 2021. These include programs such as virtual care and increased pharmacy benefits. For a summary from the National Business Group on Health , click here. For the survey, click here.
US Doctors Traveling to Mexico To Perform Surgeries at Lower Costs
A new development in medical tourism: American doctors traveling to Mexico on their days off to give cheaper surgeries to American patients and getting paid more. Hospital costs in the US are now high enough that it makes financial sense for American patients and doctors to perform medical procedures in private Mexican hospitals. American company NASH has re-created medical tourism, signing up patients and doctors. For the New York Times report, click here.
UnitedHealth Care Says Cutting Hospital Price Growth Is Key
The nation’s largest insurance company is making the case to slow the growth of hospital prices as a means of substantially reducing the cost of health care in the United States.  In a new report, UHC says if hospital price increases had the same growth rate as physician prices, by 2029 patients and employers could save an estimated $250 billion. For the full article from United Health Group, click here.

Health Insurance Exchange Enrollment Drops: CMS
Health insurance enrollment declined among people who do not qualify for financial help under ObamaCare as premiums rose to make coverage less affordable, new federal data shows. The data released by CMS last week shows that enrollment declined by 1.2 million people, or 24 percent, between 2017 and 2018 among people with incomes too high to qualify for ObamaCare subsidies. Click here for the news coverage. Click here to view CMS’ Early 2019 Effectuated Enrollment Report and here for the Trends in Subsidized and Unsubsidized Enrollment Report.

California’s Surprise Billing Law May Force More Consolidation: Study
Despite California law AB-72’s success in stopping surprise bills, it may have other complications. Based on interviews with stakeholders, a study from RAND concluded that the law favors payers potentially leading to market consolidation. Smaller practices are incentivized to join larger hospitals or medical systems in order to maintain bargaining power with insurance companies. For the full RAND report, click here.
  • Some physicians, often radiologists, anesthesiologists, and emergency physicians, intentionally stay out of network in order to charge patients at higher rates, according to a new Health Affairs article. This occurs despite a general consensus that price negotiations should be between insurers and providers, not patients. According to the authors, who are siding with the insurance industry, the solution is benchmarking the dollar amounts that insurers are required to pay providers for an out of network bill. For the Health Affairs report, click here.
Trump Administration Wants The US to Import Drugs from Canada, Canadians Do Not
Many Canadians believe that the Trump Administration’s plan to import drugs from Canada in order to decrease US drug prices will make an already-pressing drug shortage problem worse and increase prices for Canadians. Prime Minister Justin Trudeau’s administration has the power to prohibit pharmaceutical trade to the US, but the Canadian parliament may do so as well in order to make a stronger statement. The Canadian Health Minister has begun to meet with stakeholders, such as pharmacists and patients to see if importation would be viable. For the report, click here.
FCC Considers a National 3-Digit Suicide Hotline
Suicide in the United States has reached epidemic levels. In order to make it easier for people experiencing suicidal thoughts or actions to get help, Congress passed the National Suicide Hotline Improvement Act of 2018. This legislation seeks to make the suicide hotline more accessible, with an easier hotline than the current 1-800-273-8255 (TALK). The FCC is considering the number 988. For the FCC report, click here.
  • Suicide rates are only increasing: 19 percent in urban areas, and 52 percent in rural areas since 1999. Rural health suffers, and rural mental health even more. Click here for a report on Eastern Montana’s single psychiatrist and the state of rural mental health.

U.S. Preventive Services Task Force Reverses Decision on Illicit Drug Screening
The task force, which has the goal of solving the opioid addiction crisis, has announced that they now suggest that physicians ask adults about their illicit drug habits in order to diagnose addiction and treat patients effectively. This is a reversal of a 2008 decision not advising doctors to screen patients, and the task force says that they have moderate confidence that this will help the opioid crisis. For the full report from the Wall Street Journal, click here.

HHS Awards $400 Million To Fight Opioid Crisis
HHS awarded nearly $400 million to combat the nation’s opioid crisis. The investments will enable HRSA-funded community health centers, rural organizations and academic institutions to establish and expand access to integrated substance use disorder and mental health services. More than $200 million was awarded to 1,208 health centers across the nation to increase access to integrated behavioral health services, including the prevention or treatment of mental health conditions and/or substance use disorders, including opioid use disorder through the Integrated Behavioral Health Services (IBHS) program. View a list of IBHS award recipients here.  HRSA’s Federal Office of Rural Health Policy is awarding more than $111 million to 96 rural organizations across 37 states. These funds, which also include an evaluation of the initiative, will strengthen rural communities’ capacity to provide needed SUD prevention, treatment, and recovery services and build the evidence base for interventions that are effective in rural settings. Click here for recipients.
FDA Proposed Rule Suggests Graphic Warning Requirement on Cigarettes
Taking a more scientific approach to cigarette-deterrence, the FDA has proposed issuing new warnings, such as “tobacco smoke can harm your children” and “smoking causes head and neck cancer.” These warnings would be accompanied by graphic pictures of people suffering from disease caused by smoking. This is part of a larger campaign by the FDA to reduce smoking rates and protect children from cigarette smoke. For the press release from the FDA, click here.
Trump Administration Delays Legislated Diagnostic Imaging Changes
Five years ago, Congress passed legislation that requires doctors to follow medical guidelines that prohibit unnecessary CT scans, MRIs, and other imaging for Medicare recipients. Diagnostic imaging is expensive and can be wasteful, according to the critics who wanted it curtailed. CMS has now put off implementation of this law until 2022 or 2023. Click here for details.
Hospital Charity Care in California Has Dropped Dramatically Since 2013
Due to the Affordable Care Act, the number of uninsured patients in California hospitals has fallen, leading to a reduction in free or reduced-cost care. Although nonprofit hospitals have replaced that charity care with community programs, advocates say that the need for charity care still exists, it has just evolved, for example, to address high out-of-pocket costs. Click here for the report.
Nurse Practitioners Push for Flexibility in Practice
Nurse Practitioners work in many ways similar to primary care physicians. However, many states limit their practice. For instance, despite evidence that nurse practitioners provide care that is no worse than that of doctors, 28 states do not allow them the same autonomy that doctors have. States such as Pennsylvania are considering relaxing medical licensing restrictions. For the report from the Washington Examiner, click here.
500,000 Children on Medicaid Lack Appropriate ADHD Follow Up Care
ADHD rates among children have risen in the past few decades, and without proper treatment the disorder can be highly distressing and even dangerous for the child and those around them. According to a study by the HHS Office of the Inspector General (OIG), many Medicaid recipients who have been hospitalized for ADHD related causes have not received the recommended maintenance and follow-up treatments. This puts them at higher risk for negative outcomes, such as suicide or criminal behavior in adulthood. For the report from OIG click here.
Racial Equity for Premature Babies Improving, but White Babies Still Have Better Outcomes
A study published in American Academy of Pediatrics concluded that disparities in health outcomes for premature babies are narrowing. However, Blacks and Latinos are still more likely to have more negative health outcomes. The study suggests that hospitals with high minority populations develop training programs focused on premature children. For the full study, click here.
Teen’s Mental Health and Wellbeing Suffering Under Social Media
The impact of social media usage has been linked to the mental health of adolescents. A recent study published in the Lancet, quantified that impact with participants 13-16 years old. Girls were found to have lower wellbeing scores, which decreased further when they indicated persistent, frequent social media use. The study also evaluated the impact that cyberbullying, sleep adequacy, and physical activity could have as an additional mediator to the wellbeing of participants. To read the full study, click here.
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