Weekly E-bulletin

Senate Will Proceed, or Not, on ObamaCare Repeal This Week; CBO Has New Analyses

This is expected to be the week of reckoning for the Senate and the Affordable Care Act.  Senate GOP Leader Mitch McConnell (R-KY) says he is moving forward and the first key vote will be the Motion to Proceed (TMP). This procedural vote needs a majority to pass – including a possible tie-breaking vote from the Vice President. With Sen. McCain (R-AZ) out with a serious medical condition (and he is seen as likely vote in favor of TMP), it appears that McConnell won’t be able to get a majority vote. All Democrats (48 of them) will vote no on the MTP. Key points:

  • There are at least 3 moderate GOP votes against the proposed legislation that would significantly curtail Medicaid spending. There are at least 3 conservative GOP votes against legislation that is not just outright repeal. Either way, the GOP doesn’t appear to have the votes to pass TMP.
    • McConnell’s repeal and replace bill would cause 22 million to lose their coverage, according to a new CBO score.  Click here.
    • The AARP is urging senators to vote against TMP.  Click here for their letter sent late last week.
  • McConnell’s latest repeal bill and a section-by-section summary is attached. The CBO says the repeal bill would cause 32 million Americans to lose their coverage but save the government about $450 billion over ten years. Click here for the CBO summary.
  • 20 GOP senators met Thursday night for several hours to determine if there was a way to bridge the gap and move some legislation. There was much optimism expressed after the meeting, but no conclusion. McConnell still says there will be a MTP vote next week…period.
  • If the legislation falls, a bipartisan group of senators are already vowing to hold hearings on ways to fix the ACA. First on the list of fixes is shorting up the exchange subsidies and stabilizing the marketplaces. The Trump Administration has announced that it would pay the subsidies for July, but made no commitment beyond that.

Did Hospitals Profit from Obamacare?

A story out last week says that some of the nation’s biggest hospitals have taken advantage of the new revenue created by the Affordable Care Act by taking in more money but reducing their charity care.  Click here for the story. Click herefor a related report focused on the Cleveland Clinic.  Click here for the response from the American Hospital Association.


340B on the Hot Seat: Representatives Voice Concerns Over Accountability

A key House subcommittee held a hearing to examine Health Resources and Services Administration’s oversight of the 340B drug pricing program. House members raised concerns about how hospitals utilize the savings from the program. Rep. Tim Murphy (R-PA), chairman of the Subcommittee, noted that participating hospitals are not required to report how they use the savings from the discounted drugs. Witnesses, including Captain Krista M. Pedley, director of the Office of Pharmacy Affairs at HRSA, were unable to address where these savings go. Questions were also raised over the growth in contract pharmacies and “child sites.” Members indicated that they will work with HRSA to develop legislation to address these concerns.  Click here for the OIG’s testimony.  Click here for the GAO’s testimony. Click here for HRSA’s testimony. Click here to view the hearing.

  • Hospitals are fighting government efforts to curtail the 340B program.  Click here for the WSJ story.

New CMS Map Shows Where Exchange Insurers Are and Are Not in 2018

CMS has posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through July 19, 2017. The map currently shows that nationwide 40 counties are projected to have no issuers, meaning that Americans in these counties could be without coverage on the Exchanges in 2018. It’s also projected that as many as 1,332 counties – over 40 percent of counties nationwide – could have only one issuer in 2018. Click here for the map.


Health Spending Driving Federal Budget Deficit: CBO

If current laws governing taxes and spending did not change, the condition of the federal budget would worsen considerably over the next three decades. CBO projects that federal spending on the major health care programs would grow larger than spending in any other category if current laws generally remained unchanged. Driven particularly by growth in Medicare outlays, spending on those programs would account for 40 percent of federal non-interest spending in 2047, compared with 28 percent today. Two factors explain the projected growth in spending on major health care programs: aging of the population and rising health care costs per person. Click here for the CBO slide deck.


House Appropriators Approve Funding Cuts for Health Care Programs

The House Appropriations Committee last week approved the draft fiscal year 2018 Labor, Health and Human Services, and Education (LHHS) funding bill that includes $156 billion in discretionary funding, which is a reduction of $5 billion below the fiscal year 2017 level. House Republicans defeated amendments that would have restored funding for Obamacare, Planned Parenthood and fetal tissue research. While the draft increases funding to NIH, it decreases funds to CMS, CDC, and HRSA. To view summary of the bill, click here, for the bill report, click here, and the bill language, click here.


Farmers/Ranchers Worried About Healthcare Too

According to a new survey from the University of Vermont and the University of Chicago that looked at farmer attitudes about health care insurance, the lack of access to affordable health insurance is one of their most significant concerns. More than 90 percent of respondents said they were covered by some form of insurance, however 52 percent said they are not confident they could pay for the costs associated with a major illness without going into debt. Of the farmers and ranchers surveyed, 64 percent reported having a pre-existing health condition and 73 percent said that having affordable health insurance was an important or very important means of reducing their business risk. Click here to read the study.


U.S. Birth Rate at Historic Low

Women in the United States continue to have fewer children, and when they do, they are usually in their 30s instead of their 20s. New data from the CDC show the U.S. fertility rate in 2016 was a historically low 62 births per 1,000 women, down from the 62.5 rate in 2015.  Click here for the CDC report.


FDA Warns of Grapefruit Impact on Certain Drugs

The FDA has issued a consumer warning of the affects grapefruit and grapefruit juice has on certain medications, especially for high blood pressure or arrhythmia (irregular or abnormal heart beat). The FDA has required that some prescription and over-the-counter drugs taken by mouth include warnings against drinking grapefruit juice or eating grapefruit while taking the drug. The severity of the interaction can be different depending on the person, the drug, and the amount of grapefruit juice the patient drinks. To read the consumer warning and to review the list of drugs, click here.


Social Interactions Helps Cancer Patients: Study

Cancer patients were a little more likely to survive for five years or more after chemotherapy if they interacted during chemotherapy with other patients who also survived for five years or more, according to a new FDA study. Researchers stated that “A two percent difference in survival – between being isolated during treatment and being with other patients – might not sound like a lot, but it’s pretty substantial,” adding “If you saw 5,000 patients in nine years, that 2 percent improvement would affect 100 people.” Click here to read more about this study.


GAO Pushes Use of Claims Data to Get More Accurate MA Payments

In a report released last week, GAO recommended that CMS should utilize ‘encounter data,’ or medical claims records, to more accurately determine proper Medicare Advantage payments. GAO states “Encounter data include more information about the care and health status of MA beneficiaries than the data CMS uses now to risk adjust payments.” CMS has proposed increasing the use of encounter data in recent years, however they have received strong push back from the insurance industry, that argues that the records are unreliable. In 2016, CMS determined that 10 percent of MA payments that year or about $16 billion in payments, were improper. To read the entire report, click here.


10 States Recognized for Outstanding Quality in Critical Access Hospitals

The Health Resources and Services Administration recognized ten states last week for outstanding quality performance of their Critical Access Hospitals by achieving the highest reporting rates and levels of improvement over the past year. The ten states – Indiana, Illinois, Maine, Massachusetts, Michigan, Minnesota, Nebraska, Pennsylvania, Utah, and Wisconsin – used funds for quality improvement projects and developing technical assistance resources that improve high-quality care in their communities.  Click here for more from HRSA.



The FDA has given the green light to the first MRI designed specifically for infants in the neonatal intensive care unit. Right now, doctors have to take infants out of the NICU and wheel them down to regular MRI suites to capture images of the body’s internal structures. The new system, however, has a specially designed incubator built right into the MRI machine to minimize the amount a baby has to be moved.  Click here for the FDA announcement.


Analysis Shows Hospitals Cut Back on Blood Utilization

A national analysis released by Premier last week found that hospitals decreased blood utilization by 20 percent across 134 diagnoses that account for 80 percent of red blood cell use. Researchers reviewed inpatient data from 645 facilities, representing more than 27 million discharges. The analysis suggests that hospitals have become more efficient at managing a critical, if high-cost service; blood transfusions can cost more than $1,000 per unit. Among the specialties reviewed, orthopedic surgeries have seen a steady drop in transfusions recorded over more than a five-year period down 72.4% for major joint replacements. To read the study, click here.


Top Hospitals Picked By Physicians

Medscape has released survey results of 8504 doctors across more than 25 specialties as to the best hospitals for treatment of a complex or difficult condition, assuming no barriers to treatment at their preferred hospital. Physicians ranked New York City-based Memorial Sloan Kettering Cancer Center, Cleveland Clinic and the University of Texas MD Anderson Cancer Center in Houston among the top hospitals across various specialties. When describing their preferences, respondents considered whether the hospital could provide medically respected physician expertise (42 percent), maintained a good reputation among colleagues (19 percent) and had a specific physician at the facility (13 percent). To read the full list of all the specialties and the top hospitals in the different categories, click here.











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