September 18, 2017

New ACA Repeal, Replace Bill May Be Just 2 Votes Short in the Senate

Legislation developed by Senators Lindsay Graham (R-SC) and Bill Cassidy (R-LA) to repeal and replace Obamacare has 48 GOP votes, according to a variety of sources and there may be 3 undecided Republican senators.  The GOP needs only 50 votes, plus a tie-breaker from Vice President Pence, pass its legislation under budget reconciliation rules that expire at the end of September.  Click here for a section-by-section summary of the bill,   Click here for a descriptive summary of the formulas used in the bill.  Click here to see how much each state would receive under the bill’s block grant program.  Click here for the Washington Post summary.

  • One of the solid “no” votes on the bill is Senator Rand Paul (R-KY).  Earlier last week, Senator Orrin Hatch (R-UT) said it was unlikely the bill would get a floor vote.  Click here for the story.
  • House GOP leadership has thrown its support behind the bill.  Click here.
  • Click here for a good summary of the bill’s Medicaid provisions from Health Affairs.
  • Another analysis says the bill guts pre-existing conditions protections.  Click here.
  • Fitch Ratings is warning that the repeal bill would drastically change the way health care is paid for and administered around the nation, forcing some states to immediately absorb deep funding cuts and eventually leaving every state with new budgetary challenges. Click here for the Fitch report.

Democrats Rally Around Sanders’ Medicare-for-All Bill

Following through on last year’s presidential campaign promises, Senator Bernie Sanders (D-VT) last week introduced his Medicare-for-All single payer legislation, S.1804.  Click here to see the list of 16 other Senate Democrats who cosponsored the bill.  How to pay for the bill?  Sanders offers 6 pages of options to finance Medicare-for-All, click here.

  • Click here for a summary of the bill.
  • Click here for a section-by-section summary.
  • Click here for the text of the bill.
  • Click here for a good NYTimes review.

Bipartisan Senate Effort to Fix Obamacare Exchanges Could Move This Week

Health committee chairman Lamar Alexander (R-TN) is expected to produce a bipartisan compromise bill this week that would provide a fix to the Obamacare insurance exchanges.  Republicans and Democrats on the committee have been working to find an elusive compromise that would move the bill to the Senate floor.  The Trump Administration has been approving the insurance exchange subscriber subsidies on a month-to-month basis.  Insurers have until September 27 to finalize their participation on the exchanges and have been pushing for more permanent subsidies. Click here for a summary of provisions that could be in the bill when it is released.

  • 31 House Democrats sent support letter to senate committee leaders urging action.  Click here for the letter.
  • Another group of House Democrats also sent a support letter.  Click here.
  • Click here for a good article on what’s working against this legislation.
  • HHS is cutting most of the funding for exchange navigators.  Click here for the report.
  • Counties in 2017 with only 1 participating insurer have 9.6% higher premiums than those counties with 2 participating insurers, and 15.3% higher premiums than those counties with 3 or more participating insurers. The latest data from CMS shows that 29% of exchange participants, or 2.6 million people, will have 1 plan to choose from in 2018.  Click here for the Avalere study.

New CBO Report Says ACA Will Stabilize and Premiums Will Moderate

In a new report, the Congressional Budget Office projected that if the ACA’s insurance premium subsidies and the individual mandate are left in place, premiums will rise modestly through 2026 and the rate of uninsurance will stabilize near the current rate. The projections are, however, based on the assumption that current law — i.e., the ACA — remains intact through the 2017-2026 period.  Click here for the report.  Click here for the Washington Examiner’s conservative take on the CBO report.

  • There is growing recognition of the importance of not only integrating and coordinating services across providers and settings within the health care system, but also connecting and integrating health care with social supports and services that address the broad range of social and environmental factors that impact individuals’ and communities’ health and well-being. Click here to see more about a very successful digital tool that is making this happen across the country.

Hospital Spending At Historic Low

A new analysis finds that health care spending growth slowed in August. Driving the low overall spending growth is hospital spending, which is at a historic low, according to an study of health economic indicators from Altarum’s Center for Sustainable Health Spending. Hospital spending, at a revised .8% June growth rate, is the lowest year-over-year monthly growth rate recorded in more than 25 years.  Click here for the report.


Whither Innovation Led by the Federal Government?

A new analysis says the Trump Administration is pulling back on Obama-era initiatives designed to spur health care innovations.  Not needing congressional action, the Department of Health and Human Services is cutting regulatory initiatives, like bundled payments, and not pursuing recommendations to create new Advanced Alternative Payment Models.  Click here for the story.


HHS Announces $144.1 Million in Substance Abuse Grants

HHS last week announced $144.1 million in grants dedicated to help prevent and treat those suffering from opioid addiction. The grants will be administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). The funding will be distributed to 58 recipients, including states, cities, healthcare providers and community organizations and will be awarded for three to five years, subject to availability and depending on the program. Some of the grants were authorized and funded through the Comprehensive Addiction and Recovery Act (CARA) passed by Congress last year. For more on the grants from HHS, click here.

  • The FDA has approved the first mobile app treatment for substance abuse. The app, developed by Pear Therapeutics, is designed to be prescribed by a clinician and used alongside counseling for cognitive behavioral therapy. Click here.

Senate Committee Announces Deal on CHIP Reauthorization

The Senate Finance Committee last week announced that they have agreed to a five-year funding extension for the Children’s Health Insurance Program. Chairman Orrin Hatch (R-UT) and ranking member Ron Wyden (D-OR) made the announcement as the end of September deadline to extend federal funding for a program that covers roughly 9 million low-income children gets closer. The proposed legislation would maintain the ACA’s 23 percent increase in the federal matching rate to states for 2018 and 2019 and begin to decrease the funds in 2020 according to sources. The House Energy and Commerce Committee has not unveiled legislation. The Committee stated that the full legislative text will be released in the coming days. Click here for more from the Finance Committee.

  • When will states exhaust their CHIP funds?  Click here for a good report from MACPAC with each states’ deadline.

LTCH, IRF, Hospice Quality Data Ready for Review: CMS

CMS announced that Inpatient Rehabilitation Facility (IRF), Long-term Care Hospital (LTCH) and Hospice Quality Reporting Program (QRP) Provider Preview Reports are now available. Providers are encouraged to review their performance data on each quality measure based on Quarter 1 – 2016 to Quarter 4 – 2016 data, prior to the December 2017 IRF, LTCH and Hospice Compare refresh, during which this data will be publicly displayed.  Providers have 30 days to review their performance data (September 1, 2017 through September 30, 2017). Corrections to the underlying data will not be permitted during this time. However, providers can request a CMS review during the preview period if they believe their data is inaccurate.  Click here for the IRF info.  Click here for the LTCH info. Click here for the Hospice info.


Worldwide Diabetes, Heart Disease, Chronic Illness Epidemic Fueled by Obesity Boom

A New York Times examination of corporate records, epidemiological studies and government reports — as well as interviews with scores of nutritionists and health experts around the world — reveals a sea change in the way food is produced, distributed and advertised across much of the globe. The shift, many public health experts say, is contributing to a new epidemic of diabetes and heart disease, chronic illnesses that are fed by soaring rates of obesity in places that struggled with hunger and malnutrition just a generation ago. Click here for the story.


New Global Cardiovascular Initiative to be Lead by Former CDC Director

Thomas Frieden, the former Director of the Centers for Disease Control, will lead a $225 million initiative aimed at reducing deaths caused by cardiovascular disease. In the announcement last week, Frieden said the initiative would seek to partner with existing non-governmental organizations and public health groups worldwide to fight against smoking, reduce fat and sodium intake and improve access to treatment for high blood pressure. The global initiative, known as “Resolve,” will be part of the global health organization Vital Strategies and draw its funding from donated by Bloomberg Philanthropies, the Chan Zuckerberg Initiative and the Bill and Melinda Gates Foundation. For more on the initiative from Vital Strategies, click here.


Uninsured Rate Continues to Fall: Census Bureau

According to the latest Census data, the rate of uninsured Americans dropped to 8.8 percent last year, a 0.3 percentage point decrease from 2015. A total of 28.1 million Americans were uninsured all of last year, a drop of 900,000 from 2015. Additionally, The percentage of people with health insurance coverage for all or part of 2016 was 91.2 percent, higher than the rate in 2015. Before ACA exchanges opened in 2014, the uninsured rate stood at 13.3 percent. Click here for the full Census report on health insurance coverage.  Click here for a state-by-state look at how the ACA impacted the uninsured rate.


New Poll Shows Americans Less Inclined to Use Pain Meds

A new Gallup poll released last week found that 78 percent of respondents would prefer other methods for pain treatment before they use a prescription medication, while 22 percent said they preferred to take pain medication. Most of those surveyed stated they were aware of the national opioid epidemic but had different views on the cause of the epidemic. About 55 percent blame pharmaceutical companies encouraging doctors to prescribe opioids, while 53 percent stated that doctors were equally to be blamed for overprescribing pain medications. Slightly less than half attributed the problem to a lack of awareness about the dangers of taking opioids and 47 percent blamed it on patients demanding prescriptions to deal with their pain. To read the full survey, click here.


Hospitals Urge Congress to Stop DSH Cuts

A group of hospitals that care for uninsured and vulnerable populations last week sent a letter urging Congress to stop looming cuts to Medicaid disproportionate share hospital (DSH) payments. Leaders of more than 250 hospitals and health systems sent the letter to House and Senate Committee Leadership warning that the cuts could “limit your constituents'” access to care. The ACA mandated DSH money be cut by $43 billion between fiscal 2018 and 2025. The law’s Medicaid expansion was thought to make up for those payments, but 19 states did not expand their programs, leaving hospitals in those states without new funding. Congress has previously delayed the cuts, but the latest extension runs out on Sept 30. Click here for the letter.


VA Inspector General Finds Payment Errors in Private Care Program

According to a memorandum from the VA’s Inspector General, the program Congress created in 2014 to pay for veterans to seek medical care outside of VA hospitals has resulted in payment errors in the tens of millions of dollar. The problem chiefly lies with VA overpayments to private companies working as administrators of the program. This memo outlines key issues for lawmakers as they contemplate how to change the program. Auditors described in the memo how the VA overpaid companies performing administrative functions for the Choice program, in large part because of its rush to serve veterans seeking medical care and a lack of adequate controls on bill processing. To read the memo, click here.


House Passes Fiscal Year 2018 Spending Bill with More Health Care Cuts 

The House voted 211-198 to pass the $1.23 trillion omnibus spending package, funding the government for Fiscal Year 2018. The bill includes a total of $77.6 billion for HHS, a decrease of $542 million below last year’s enacted level and $14.5 billion above the President’s budget request. The legislation (HR 3354) now moves to the Senate where Democrats object to its funding levels and policy riders, and have the votes to block it.  Click here for more from the House Appropriations Committee and to read the sections of the legislation.


FDA OKs First Biosimilar to Treat Cancer

The Food and Drug Administration approved the first biosimilar – essentially generic versions of expensive and complex biologics – to treat cancer. The drug, Mvasi, is the biosimilar version to Avastin, according to an FDA press release. Click here for the FDA announcement.


New Computer Programs Are Assuring the Right Patient Diagnoses

A flood of new initiatives by researchers, physicians, health-care systems, nonprofits and malpractice insurers is yielding new insights and approaches to help assure that the right patient diagnoses are made. These include sophisticated computer programs, some that use artificial intelligence to help analyze and diagnose tough cases, and others that scan records for errors such as missed test results and appointments. Click here for the WSJ story.

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