21 Dec December 21, 2018.

Senior House Democrats’ New Bill Ramps Up the Medicare Expansion Debate
Earlier this week, Congresswomen Rosa DeLauro (D-CT) and Jan Schakowsky (D-IL) introduced legislation, the Medicare for America Act, that would greatly expand Medicare coverage while maintaining employer-sponsored health insurance for those who have it and want to keep that coverage, employers would have an option to pay for their employees to be in the new system. Under the proposal Medicare plan beneficiaries would still be required to pay premiums and insurance deductibles however, those costs would be capped, with premiums set at a maximum of 9.69 percent of the individual’s income. The plans would also be required to cover prescription drugs, dental, vision, and hearing services, as well as long-term supports and services for seniors and Americans with disabilities. The bill is funded by phasing out the GOP tax cuts put in place last year as well as creating a 5 percent capital gains tax on high income earners, raising Medicare payroll and net investment income taxes, and increasing taxes on goods like tobacco, beer, liquor and sugar-sweetened drinks. Additionally, states would be required to pay into the system. Click here for the legislation, and here for a summary.

Congressional Fight on DSH Set to Begin
Sen. Marco Rubio (R-FL) jumped into the disproportionate-share hospital funding debate this week with the State Accountability, Flexibility, and Equity (SAFE) for Hospitals Act that would overhaul the billions distributed by the program. Florida receives one of the lowest allotments in the country the Rubio bill would tweak the DSH funding formula so a state’s allotment is based on its overall population of adults below poverty level leading to hospitals that care for higher amounts of poor patients receiving more money. Additionally, the bill would redefine the hospital costs that count as uncompensated care to include some outpatient physician and clinical services. Under current law substansive DSH cuts go into place on Sept. 30, 2019 unless Congress acts. The Medicaid and CHIP Payment and Access Commission discussed proposed recommendations on DSH allotment reductions at its December meeting which included –

• Phasing in reductions more gradually over a longer period of time -$2B in FY 2020, $4B in FY 2021, $6B in FY 2022 and $8B a year in FYs 2023-2029;
• Applying reductions to unspent DSH funding first; and
• Distributing reductions in a way that gradually improves the relationship between DSH allotments and the number of non-elderly, low-income individuals in a state.

MACPAC The Commissioners are expected to vote on the recommendations at the January 24-25 meeting. Click here for a summary of the Rubio bill and here to view the MACPAC presentation.

Congress Sends Bills for TBI, Alzheimer’s, and Heart Disease Research, and Rural Health Programs to the President
Before heading home for the holidays, Congress sent a number of health bills to the President for his signature including research programs for TBI, Alzheimer’s, and congenital heart disease as well as funding for state rural health offices.

• The Traumatic Brain Injury Program Reauthorization Act of 2018 (H.R. 6615) will authorize $6.75 million annually from fiscal 2019 through 2023 for CDC programs related to traumatic brain injury prevention and surveillance, provide $7.32 million annually for state grants for traumatic brain injury projects under the Administration for Community Living, and additional funding for concussion surveillance and legal services for people and families with TBI, click here.
• The Congenital Heart Futures Reauthorization Act of 2017 (H.R. 1222) will direct HHS to expand research and data collection on congenital heart disease, improve public awareness, and award grants, click here.
• The BOLD Infrastructure for Alzheimer’s Act (S. 2076) will expand federal activities to address Alzheimer’s disease and related dementias and authorize $20 million annually from fiscal 2020 through 2024 for grants and cooperative agreements, click here.
• The State Offices of Rural Health Reauthorization Act of 2018 (S. 2278) will reauthorize grants for state rural health offices through fiscal year 2022 and make several make several changes to grant requirements, click here.

Open Enrollment Ends with 8.5 Million Signed-Up
Dec. 15th marked the last day of open enrollment for ACA Marketplace plans 8.5 million people choosing a health plan through Healthcare.gov, about 300,000 less than last year. Overall, this is a 4-percent drop from 2017 sign-ups. CMS suggests that the lower numbers are due in part to a increase in employment by about 2 million, and 90-percent of U.S. workers have health benefits from their employers as well as the continued expansion of state Medicaid programs. Health experts also point to the removal of the individual mandate come January and budget cuts to advertising and outreach programs. To view the final “snapshot” on enrollment from CMS, click here.

VA Still Facing Major Uphill Battle with Choice Program
According to a new report released by ProPublica, the VA Choice Program – a program created to streamline and expand the private sector’s role in veterans’ healthcare – has resulted in longer wait times and a cost more money then initially thought. The report details how the two private contractors hired to run the program have been paid nearly $2 billion for overhead, including profit, since 2014, or 24% of the companies’ total program expenses. The VA paid the contractors at least $295 every time it authorized private care for a veteran which was sometimes bigger than the doctor’s bill. Additionally, under the new program, veterans had to wait  at least 30 days 41% of the time, and sometimes they had to wait as long as 70 days. The report was released just in time for Congressional Veterans’ Affairs Committee to get updated by the Secretary of Veterans Affairs Robert Wilkie who acknowledged that the VA got a bad deal in paying nearly $2 billion in fees to companies responsible for booking veterans with private doctors. Wilkie avoided blaming the companies directly, and instead faulted Congress for giving the VA only three months to launch the program. Click here to view the Joint Hearing, and here for the ProPublica report.

FDA Recommends Co-Prescribing Naloxone with Certain Painkillers
By a close vote of 12-11, an FDA advisory committee endorsed updating opioid labels to recommend that the overdose antidote naloxone be prescribed at the same time as the pain medication. The guidance recommends that clinicians prescribe or co-prescribe naloxone to individuals at risk for opioid overdose, including, but not limited to: individuals who are on relatively high doses of opioids, take other medications which enhance opioid complications or have underlying health conditions. The Committee did note that prescribing naloxone is not the most efficient way of tackling the opioid crisis, and that is why they suggest co-prescribing only to high-risk patients, in part to avoid shortages and price increases of the antidote. Click here for more from HHS.

Senator Questions Connections Between Pain Task Force Members and the Drug Industry
In a letter to the HHS Secretary Alex Azar, Sen. Ron Wyden (D-OR) raised concerns over the fact that many members of a new HHS pain management task force formed to address the opioid crisis have taken money from the drug industry in recent years. The Ranking Member of the Senate Finance Committee suggested that HHS is “inadequately vetting advisory board members for conflicts of interest related to medically prescribed opioids.” Wyden would like HHS to explain how it reviewed potential financial conflicts after finding that 10 individuals on the panel received nearly $180,000 in total payments between 2013 and 2017 from pharmaceutical companies, specifically calling out two members – one who received $79,000 from Pfizer and one who received $24,600 from Purdue Pharma. To view the letter, click here.

Drug Prices Due to Rise in 2019
28 pharmaceutical companies will raise their drug prices next year going back on the price freezes that they instituted this summer after public shaming from Administration officials, according to press reports. Allergan, Bayer, Novartis, Amgen, AstraZeneca, Biogen, and GlaxoSmithKline are among the companies who filed disclosures with California earlier this year that they planned to raise prices within at least 60 days, in accordance with the state’s 2017 notification law. Payers have reported that they anticipate drug price increases about 20 percent higher than previous years with the average price increase for a pharmacy-dispensed drug to be in the high single digits and the increase for physician-administered drugs to be around 3 percent. Click here for the Reuters report.

71 Percent of Hospitals Participate in a Nationwide Health Information Exchange System
About 7 in 10 hospitals participated in at least one nationwide health information exchange in 2017, and 4 in 10 used multiple networks, according to the Office of National Coordinator. Unfortunately, one-quarter of hospitals in the U.S. are still not using any electronic method to routinely receive summary of care records and two-thirds of respondents say they “often” or “sometimes” send data via mail or fax health records. The ONC stated that hospitals that used more electronic methods to receive summary of care records were more likely to have and use patient health information electronically available at the point of care and warned that small, rural, and CAHs had higher rates of using non-electronic methods to send and receive summary of care records with sources outside their hospital system than their counterparts. Click here for the report.

Report Looks at ACO Management Alliances
A new paper published in Milbank Quarterly examines the up and coming industry seeking to manage accountable care organizations and what these companies do and why certain ACOs have choosen to partner with them. Trust, Money, and Power: Life Cycle Dynamics in Alliances Between Management Partners and Accountable Care Organizations focused on two Medicaid ACOs, finding that tensions typically emerged over power and financial issues. Using data collected between 2012 and 2017, revealed that management partners brought specific skills and services and also gave providers confidence in pursuing an ACO but, difficulties generally emerged over decision‐making authority, distribution of shared savings, and conflicting goals and values. To read the report, click here.

Joint Departmental Plan to Lower Children’s Lead Exposure Unveiled
HHS, EPA, and HUD released a cross-governmental plan to increase efforts to reduce children’s exposure to lead. The Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts would will help federal agencies work strategically and collaboratively to reduce children’s exposure to lead by laying out the ongoing efforts, such as having EPA establish standards for lead in dust, increasing HUD’s review of public housing projects for the potent neurotoxin, and HHS working to set higher standards for occupational lead exposure. Click here to read the plan.

FDA Plans to Go Undercover as Surgeon General Warns of Teen E-Cigarette Epidemic
According to various reports, the Food and Drug Administration will begin buying e-cigarettes undercover to ensure stores follow protocols and target sites where kids commonly access these products such as convenience stores. While, this week, the U.S. Surgeon General Jerome Adams released a statement earlier this week saying that the number of high school-age children using e-cigarettes rose more than 75-percent and middle school children increased usage by 50-percent in 2018 compared with last year. Using data from National Institutes of Health’s Monitoring the Future survey, the repot shows a dramatic increase in their use of e-cigarettes in just a single year, with 37.3 percent of 12th graders reporting use in the past 12 months, compared to 27.8 percent in 2017. Click here for the Surgeon General’s statement.