27 Feb Weekly E-bulletin

House GOP ACA Replacement Plan Leaked; Governors Push Back; Mayors Weigh In Too

A draft House Republican Obamacare repeal bill that leaked out late last week would dismantle the healthcare subsidies and eliminate Medicaid expansion. The legislation, which we are told is a 2-week-old version, would remove the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. (Click here for our 1-page summary) Here’s a list of the major changes:

• Eliminate the ACA’s Medicaid expansion in 2020;

• Starting in 2020 give tax credits – based on age instead of income, in lieu of subsidies;

• Offer $100 billion in “state innovation grants” to help subsidize extremely expensive enrollees;

• Allow insurers to charge older customers up to five times as much as their younger counterparts;

• Penalize individuals who fail to maintain coverage continuously.

The legislation would be paid for by limiting tax breaks on generous health plans people get at work. The bill would cap the tax exemption for employer sponsored insurance at the 90th percentile of current premiums. That means benefits above that level would be taxed. Click here to view the draft bill. Here’s another very good analysis of the legislation from Vox – click here.

In what may be an updated version of the plan, though details have not been disclosed, the GOP may be moving towards keeping some of the expansion and helping states that did not. Click here for that report.

• Governors meeting in Washington last week were provided a detailed analysis of the changes and what impact they might have on states. Click here for this slide deck. Click here for the Washington Post story.

• GOP governors put together their own policy documents concerning what they want. Click here for their 1-page summary. Democratic governors were fairly predictable in their letter to Congress. Click here.

• In a letter to Congress last week, the U.S. Conference of Mayors voices their opposition to efforts to turn Medicaid into a block grant system, To read the full letter, click here.

• The politics around the Affordable Care Act is generating intense media coverage, particularly around the activists efforts at congressional ‘town hall’ meetings. Is it making a difference? Click here for the story.

Healthgrades Names Its Top 50 and 100 Hospitals

Healthgrades has released its 50 and 100 Best Hospitals™ for 2017. Click here for the list. The recipients “demonstrate superior clinical outcomes across the majority of common inpatient conditions and procedures and sustained this performance for at least three consecutive years.” Healthgrades says patients treated in hospitals achieving its 100 Best Hospitals Award have, on average, a 27.1% lower risk of dying than if they were treated in hospitals that did not receive this award. Click here for more info.

Key Committee To Start Moving Medical Malpractice Reform Bill

The House Judiciary Committee is set to take up legislation this week imposing broad limits on medical malpractice lawsuits. The Protecting Access to Care Act, which is scheduled for full committee markup on Feb. 28th, would tighten the statute of limitations for malpractice suits, cap certain damage awards and restrict attorneys’ fees. The legislation would also shield providers from prescription drug lawsuits involving FDA-approved drugs. Finally, the bill would require patients to file suit within three years of an injury and cap noneconomic damages such as pain and suffering awards at $250,000. Attorneys would only be able to collect up to a fixed percentage of a plaintiff’s total award. Click here to view the legislation.

CMS Extends Health Plan Filing Deadlines for 2018

CMS announced it is revising its 2017 calendar for qualified health plan certification and rate filing deadlines for 2018 plans and rates. The goal of the revised certification dates is to allow insurers more time to consider whether they will participate in the federally facilitated marketplace. The initial deadline for filing QHP applications and rate table templates for coverage is delayed from May 3, 2017 to June 21, 2017. After that date, deadlines are compressed and generally moved backwards from the earlier calendar. Click here for the bulletin announcing new rate filing deadlines; here for the revised list of key dates for 2017; and here for the addendum to CMS’ 2018 letter to issuers.

CMS Awards $20 million to 11 Organizations to Assist Small Practices with MACRA

CMS awarded approximately $20 million to community-based organizations to begin a five-year program to offer doctors in individual or small group practices of 15 or fewer providers on-the-ground training and education about the new Medicare physician payment system created under MACRA. The agency plans to invest as much as $80 million more over the next four years of the program to help providers with the Quality Payment Program. Rural practices are among those that will receive priority for this technical assistance. The training and education resources will be available immediately, nationwide, and will be provided at no cost to eligible clinicians and practices. The agency has also launched a new telephone helpline for clinicians seeking assistance with the new pay. Click here for details from CMS.

Fewer Employers Offering Health Insurance: Study

Fewer employers are offering health insurance to their workers, with smaller companies driving the decline, according to a new study from the University of Minnesota’s State Health Access Data Assistance Center. The study found that the percentage of employers offering health coverage dipped from 47.5 percent in 2014, to 45.7 percent in 2015. The percentage of firms with fewer than 50 employees sponsoring health coverage fell from 32.2 percent to 29.4 percent over that time. Click here for the study.

Most Addicts Return to Opioid Painkillers After Treatment: Study

According to a new study from Johns Hopkins researchers, the opioid addiction treatment drug buprenorphine is doing little to wean patients completely off of opioids completely. More than two-thirds of the opioid addicts in the study received a prescription for opioid painkillers within a year of taking buprenorphine, and 43 percent were taking painkillers while in treatment. Buprenorphine is a more accessible alternative to methadone that doesn’t require patients to visit a special clinic. But Johns Hopkins’ survey of pharmacy claims for 38,000 users shows most stopped treatment after just three months, and ultimately returned to using similar amounts of opioids as before. Click here for the study.

CDC: Overdose Death Rate Continued to Rise in 2015

Continuing a 16-year trend, the rate of drug overdose deaths increased in 2015, having the greatest impact among adults aged 45-54, according to a new study of national vital statistics from the Centers for Disease Control and Prevention. Overall, there were 16.3 drug overdose deaths per 100,000 people in 2015, a rate that’s been increasing about 5.5 percent annually since 1999. To view the entire report, click here.

• Congress also is investigating the epidemic, in a letter to the Office of National Drug Control Policy, leadership of the House Energy and Commerce Committee questioned whether the federal government had a handle on what they called the “urgent public health threat” posed by fentanyl. Click here for the letter.

• Opioid-related emergency department visits more than doubled between 2009 and 2014 in three states — Minnesota, Ohio and South Dakota. Click here for the report from AHRQ.

• Can marijuana ease the opioid epidemic? Maybe. Click here.

FAH and AHA Join Forces against Physician-Owned Hospital Bill

The Federation of American Hospitals and the American Hospital Association have joined together to state their “strong opposition” of legislation that would allow expansion of physician-owned hospitals. The trade groups wrote a letter to members of Congress last week in opposition to H.R. 1156, the Patient Access to Higher Quality Health Care Act of 2017, sponsored by Rep. Sam Johnson (R-Texas), and any other legislation that would repeal or modify current law to expand self-referral to physician-owned hospitals. To read the full letter, click here.

‘Social Determinants’ Are the Focus of a Growing Number of Hospitals

Hospital across the country are working to address the social determinants of health in an effort to improve the health of its communities. USA TODAY focuses on several initiative underway. Click here. Hospitals interested in participating in a national initiative to focus on these issues should consider The Root Cause Coalition, click here.

CMS Extends “Grandmothered” Health Plans Through 2018

CMS announced last week that it would extend issuers’ ability to sell ACA non-compliant individual and small group plans through most of 2018. This comes after the lobbying effort to the Trump Administration by insurers to extend the deadline for eliminating non-compliant “grandmothered” plans. CMS will allow states will the option to decide whether they want to grant this additional extension for 2018. The Obama Administration initially allowed non-compliant plans to stay in place for 2014; that deadline was extended twice, allowing those plans to remain in the market through 2017. Despite arguments that allowing people to keep non-compliant plans may have resulted in adverse selection, stakeholders want them to remain. To read the CMS notice, click here.

As America Diversifies, Health Care Responds

On any given day at the Salud Clinic, in West Sacramento, California, Lucrecia Maas might see 22 patients. They come to the community health center tucked away in an office park here needing cavities filled, prescriptions renewed and babies vaccinated. When they start to speak, it’s rarely in English. Sometimes it’s Hindi. Or Dari. Or Hmong. Or Russian. As America’s population diversifies, health care responds. Click here for the story.

CVS Selling an Epinephrine Auto-Injector for Far Less Than EpiPen

CVS Health has begun selling an EpiPen substitute, Adrenaclick manufactured by Impax Laboratories, for $110 – 80 percent cheaper than EpiPen. That price is available to anyone, regardless of whether they’re insured. EpiPen, manufactured by Mylan Pharmaceuticals, is the latest drug to make headlines for drastic price hikes, and it set the stage for brand drug makers to blame pharmacy benefit managers for taking a large cut of profits in the form of rebates. Click here for more from CVS.