December 17, 2018

Federal Court Nixes Affordable Care Act

— Confusion Grows, Congressional Leaders Vow Action, Courts Likely To Act

A federal judge in Texas on Friday ruled that the Affordable Care Act is unconstitutional now that Congress has eliminated a penalty for those who forgo health insurance. U.S. District Judge Reed O’Connor, an appointee of President George W. Bush, ruled that the entire Obama-era health law is invalid, siding with the claims of 20 Republican states that brought a lawsuit seeking to strike down the ACA. Click here for details from the Wall Street Journal.

  • The ruling came under harsh attack from legal analysts who predicted higher courts will reject the rationale as a tortured effort to rewrite not just the law but congressional history. Click here for the Washington Post report.
  • President Trump is urging congressional leaders to act and they say they will.  Click here.
  • The politics around the court decision have the GOP scrambling and Democrats vowing action in the new year.  Click here for the NYTimes story.

Trying to calm concerns about the impact, CMS Administrator Seema Verma tweeted “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.”


Congress Passes Farm Bill, Provides Help to Rural Hospitals

The House and Senate passed a compromised Farm Bill last week and sent it to the President. The $867 billion farm bill passed with strong bipartisan support allocates billions of dollars in subsidies to American farmers, legalizes hemp, bolsters farmers markets, and rejects stricter limits on food stamps pushed by House Republicans. The final version of the bill did not include provisions that would create work requirements for food stamps on older workers, those aged 49 to 59, as well as parents with children ages 6 to 12. The Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, helps nearly 40 million low-income Americans, costs about $70 billion per year, and accounts for more than three-quarters of total farm bill spending. H.R. 2 doesn’t alter SNAP benefits or change eligibility for the program in any significant way. Additionally, the bill includes a provision that would allow rural hospitals to refinance substantial debt through lower-interest loans from the U.S. Department of Agriculture. To view the bill, click here, and the Joint Explanatory Statement that accompanies it, click here.


CBO Recommends Major Health Care Cuts to Congress

Cuts to major Medicare and Medicaid programs to reduce the federal deficit are the centerpiece of a new Congressional Budget Office report to Congress. The CBO issues such a report to Congress each year and most of the budget cutting ideas rarely see the light of day.  But with federal deficits skyrocketing, there is renewed focus on ways to make major reductions to federal spending.  Among the provisions:

  • Establish Caps on Federal Spending for Medicaid (page 41)
  • Limit States’ Taxes on Health Care Providers (page 52)
  • Reduce Medicare’s Coverage of Bad Debt (page 72)

Click here for the complete report.


Congress Seeks to IMPROVE Generic Drug Pricing

Drug makers that knowingly misclassify products to avoid paying higher Medicaid rebates would be fined by HHS under the overcharge provision in H.R. 7217, the IMPROVE Act. The provisions duplicate those in a bill (S. 3702) that Sens. Chuck Grassley (R-IA) and Ron Wyden (D-OR) introduced last week. The authors of the bill created the overcharge provision citing allegations that Mylan pharmaceuticals misclassified EpiPen as a generic product, resulting in smaller rebates paid to Medicaid than if it had been classified as a brand-name drug. Provisions of the House bill can be found click here and the Senate’s click here.


Senate Passes Bi-Partisan Bill to Help Cut Back on Maternal Mortality

Responding to growing reports of higher rates of death from pregnancy and childbirth than any other developed nation, the Senate passed a bill last week that would direct states to investigate the causes of deaths from pregnancy and childbirth and to develop prevention plans. H.R. 1318, the Preventing Maternal Deaths Act of 2018, was sent to the President on Wednesday.  The bill tries to combat the more than 700 women found to have died every year, while another 50,000 experienced a near-fatal complication, according to a report by ProPublica.  To view the legislation, clickhere, and for the ProPublica report, click here.


HHS Wants Input on Reducing HIPAA Rules Burden

HHS has released a request for information on how to revise rules meant to keep health information protected and private because of growing complaints that the Health Insurance Portability and Accountability Act (HIPAA) guidelines make it harder to care for patients who need multiple specialists to deal with complex needs. In particular, HHS is looking for how changes may facilitate the transformation to more value-based health care. Public comments on the RFI are due by February 11, 2019. Click here for the HHS release on the RFI, and here for the RFI itself.


House Committee Proposes Medicare Red Tape Reduction Bills, Help for CAHs Included

Current Ways and Means Committee Chairman, Rep. Kevin Brady (R-TX), highlighted the two-year Medicare Red Tape Relief Project with all the legislation that the Committee introduced during the past two years. The legislation included bills to give providers an annual pathway to provide comments to CMS on how to reduce administrative burden, codify CMS’ quality measure removal factors, permanently get rid of physician supervision requirements for Critical Access Hospitals, and repeal the 96-hour rule for CAHs. Part of the package of bills would also would give post-acute care providers a new way to weigh in on the development of a unified post-acute care system and make sure those providers have the chance to directly engage directly with CMS. Click here for the full list of bills and a detail of the project.


Democrat Senators Introduce Bill to Stop Drug-Price Gouging

A group of Democrat Senators has introduced legislation that would allow the government to block drug price increases that it decides are unjustified. The Cure High Drug Prices Act, introduced by Senators Richard Blumenthal (D-CT), Kamala Harris (D-CA), Jeff Merkley (D-OR), and Amy Klobuchar (D-MN), was prompted by reports showing predatory pricing practices on new drugs by pharmaceutical manufacturers, including on opioid overdose and oncology drugs. Additionally, the bill would tackle unreasonable increases on drugs which have been on the market for some time that are necessary for many patients. Click here for more from the bill sponsors, and here for the legislation.


Medicare-for-All Proposals: Costly and Controversial

Several Medicare-for-All proposals have been introduced in both Chambers of Congress and a new Caucus has been created to promote the policy. Vox takes a look at the various proposals, their costs, and their proponents as a clue into what the fight will be in the new Congress. Click here for a detailed review.


Most of $3.2 Trillion in Mandatory Funding is Medicare and Social Security: GAO

According to a report by GAO released last week, the $3.2 trillion spent by federal agencies outside of the annual appropriations process, otherwise known as mandatory funding, is largely driven by entitlement programs like Medicare and Social Security. The report also highlighted that total mandatory spending by federal agencies increased by 88 percent from fiscal years 1994 through 2015. Overall, HHS reported the largest amount of spending authority and mandatory funding. To view the report, click here.


Insurance Commissioners Release First in Series of Reports on Health Cost Drivers

The National Association of of Insurance Commissioners (NAIC) released its first report in its series Rising Health Care Costs: Drivers, Challenges and Solutions. This report, released with the executive summary, is titled Food is Medicine: Why Healthier Eating Should Be a Priority for Health Care Providers, Insurers and Government.  It focuses on the importance of nutrition. NAIC intends to release six more reports in the next few months to look at health care expenditures as a key component of U.S. economic activity. Click here for the report.


United Health Foundation Report Ranks Healthiest States

According to the report, Hawaii is the healthiest state followed by Massachusetts, Connecticut, Vermont, and Utah. The 29th annual report bases its findings on thirty-five markers of health covering behaviors, community and environment, policy, clinical care and outcomes data. This year, the report found an increase in mortality rates and chronic disease, such as obesity, as more than 30 percent of American adults are considered obese. Louisiana is the least healthy state, followed by Mississippi, Alabama and Oklahoma. To read the full report, click here. Sign-Ups Lagging as Open Enrollment Closes

Saturday, Dec. 15th was the final day of open enrollment. A few days before, CMS released the latest “snapshot” of weekly enrollment from the previous week showing that sign-ups continues be about 10-percent less than last year. As of Dec. 8, there had been 4.13 million sign-ups through, about 600,000 fewer than last year through a nearly identical period in the enrollment season. Democrats have blamed the low turn-out on the Trump Administration’s severe cuts to ACA outreach and advertising. HHS contends that while they have not been doing events to boost enrollment, they are making public reminders of the looming deadline. To view the weekly snapshot, click here.


Overdose Deaths from Cocaine Up 18%; Fentanyl Deaths Skyrocket: CDC

New data released by the CDC’s National Center for Health Statistics shows that deaths in the U.S. from cocaine sharply increased by 18 percent from 2011 to 2016. The data also showed a large rise in the number of deaths from fentanyl, with deaths from the powerful synthetic opioid increasing about 113 percent each year in the same time period. The report takes a deep dive into drug overdoses data, and looks to identify the drugs that most commonly lead to overdose. Oxycodone had the most opioid overdoses in 2011 with heroin taking over as the top overdose drug from 2012 to 2015, and fentanyl caused the most overdose deaths in 2016.  Click here for the report.


CMS Sheds Light on Hospital Transparency

In anticipation of a January 1, 2019 effective date, CMS has come out with an additional set of FAQs regarding transparency in its requirements for hospitals to publicly post their standard charges. For hospitals that thought they might be exempt, CMS has clarified: any and all hospitals must comply. In addition to this, all services and items offered must be included, including but not limited to drugs and biologics. For the original FAQs please click here.


New Report: ACOs Save Medicare Money

According to a new report by the National Association of ACOs, ACOs in the Medicare Shared Savings Program have save over $665 million (after accounting for bonuses paid to ACOs) between 2013 and 2016. In contrast to this report, CMS showed that the program showed a loss of about $384 million. The Association argues that CMS’ data is skewed because it doesn’t factor in what providers would have spent without ACOs. The association’s evaluation compared ACO spending to similar non-ACO providers to determine what spending would be like in the absence of ACOs. Click here to view the full report.


HHS Advisory Committee Approves New Oncology Payment Model

The Physician-focused Payment Model Technical Advisory Committee (PTAC) voted last week to recommend implementation of the Making Accountable Sustainable Oncology Networks (MASON) model, submitted by Innovative Oncology Business Solutions (IOBS) of Albuquerque.  PTAC, established by Congress to recommend new physician payment models in government programs, approved the model that would decrease overall Medicare spending, while bettering quality of care, according to the proposal.  MASON is adopted from the Community Oncology Medical Home (COME HOME) model that aims to have cancer care administered across clinic and hospital settings. It was developed as part of a CMMI grant. In MASON, a patient is assigned to a treatment plan, based on their clinical characteristics and patient preferences, and to an Oncology Payment Category (OPC) based on disease state, co-morbidities, and treatment plan then a target price is set based on the anticipated cost of cancer care in that OPC. To view the MASON proposal, click here.

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