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April 16, 2018

Headlines in Health Policy b207ce3c-0f9e-489a-a9ba-80f9d8a56ecc

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Quotable

"Although the stated goal of the Trump administration's new health insurance marketplace rule is simplification, in at least one key way, the rule is likely to add more complexity to consumer's health plan choices in 2019. At the same time, it leaves people with less help to sort through that complexity." 
—Sara R. Collins, The Commonwealth Fund

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Affordable Care Act

  • Trump Administration Issues Rule Further Watering Down Obamacare  Reuters by Yasmeen Abutaleb — The Trump administration took additional steps to weaken Obamacare on Monday, allowing U.S. states to relax the rules on what insurers must cover and giving states more power to regulate their individual insurance markets. The Centers for Medicare and Medicaid Services (CMS) issued a final rule that allows states to select essential health benefits that must be covered by individual insurance plans sold under former President Barack Obama’s healthcare law. The 2010 Affordable Care Act (ACA) requires coverage of 10 benefits, including maternity and newborn care and prescription drugs. Under the new rule, states can select from a much larger list which benefits insurers must cover. That could lead to less generous coverage in some states, according to Avalere Health, a research and consulting firm.

  • Five Takeaways from CMS's Final 2019 ACA Marketplace Rule  Modern Healthcare by Shelby Livingston — The CMS issued a 523-page final rule late Monday that agency officials said is meant to give states more power to regulate their individual and small-group health insurance markets. The rule also furthers the Trump administration's agenda of chipping away at Affordable Care Act rules in lieu of a full repeal, which congressional Republicans haven't been able to pull off. Here are five highlights: States' choose-your-own-benefits adventure….Only rate hikes of 15 percent  or more will get a review…More "Get Out of Health Insurance Free" cards … License to innovate…Loosening up the MLR (medical loss ratio).

  • Democratic Attorneys General Fight Texas Health Care Lawsuit  Associated Press by Kathleen Ronayne — Sixteen Democratic attorneys general pushed back Monday against a Texas lawsuit aimed at striking down former President Barack Obama's health care overhaul. California Attorney General Xavier Becerra led 14 other states and the District of Columbia in filing a motion to intervene in the Texas case and defend the law, suggesting the Trump administration wouldn’t take such action. "We're taking this action to protect the health and financial security of millions of people in our country, as well as billions of dollars of federal funds that go to our states to make sure that we can afford the health care that our families need," Becerra said at a news conference. The motion sets up a battle between Democratic- and Republican-led states, 19 of which joined the Texas case that was filed in February. It argues the ACA is no longer valid because of a provision in the Republican-backed tax overhaul that removed the fines for not having health insurance.

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Medicaid

  • Medicaid Work Requirements Violate Program's Intent, Scholars Say Modern Healthcare by Susannah Luthi — More than 40 public health scholars on Friday stepped into a lawsuit challenging Kentucky's plan to enact work requirements on Medicaid beneficiaries. They argue the policy contradicts the intent of the Medicaid demonstration statute to improve the program, and that unintended consequences could lead to massive revenue drops for health centers. In an amicus brief, scholars and deans of schools of public health—including those of Columbia, Boston, Yale, and UCLA as well as prominent health law scholars like Sara Rosenbaum of George Washington University and Abbe Gluck of Yale—alleged that ratcheting back coverage will make the work requirements' impact harsher and have reverberating effects on healthcare in the communities where beneficiaries are losing Medicaid.

  • Trump Signs Order to Require Recipients of Federal Aid Programs to Work New York Times by Glenn Thrush — President Trump quietly signed a long-anticipated executive order on Tuesday intended to force low-income recipients of food assistance, Medicaid and low-income housing subsidies to join the work force or face the loss of their benefits. The order, in the works since last year, has an ambitious title — "Reducing Poverty in America" — and is directed at "any program that provides means-tested assistance or other assistance that provides benefits to people, households or families that have low incomes," according to the order's text. But its programmatic goals are considerably more modest, officials said. Many of the initiatives outlined have already been set into motion by the affected agencies, particularly the U.S. Department of Health and Human Services, which has begun issuing waivers to Republican governors who want to impose stricter work requirements on Medicaid recipients as a way to reduce costs.

  • Mainers Voted to Expand Medicaid Last Year. Could These States Be Next? PBS NewsHour by Harry Zahn - Republicans in Congress may have relented on their attempts to repeal the entire Affordable Care Act, but the battle has shifted to states. Citizens in Idaho, Utah, Missouri,and Nebraska have taken Medicaid expansion under the Affordable Care Act into their own hands via ballot initiative campaigns, hoping to force statewide votes to either adopt or reject expansion this coming November. The campaigns to expand Medicaid via ballot have varied in scope and success. After Maine voters petitioned for and passed a first-of-its-kind expansion last November, campaigns in Idaho and Utah have gained momentum to expand Medicaid coverage. In Missouri, there was a longshot effort to gather 100,000 signatures to put expansion on the state ballot. The head of the campaign, Gary Peterson, couldn't get the state Democratic party on board, only mustering support from local church groups. He told the PBS NewsHour that he suspended his campaign in February. And in Nebraska, residents launched a petition drive to appeal to voters this November after six consecutive years of failed legislation. Where is the fight over Medicaid expansion now, and where will it go next? Here’s what we know.

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Medical Marketplace

  • The Medical Marketplace Is Changing Fast Bloomberg News by Peter Orszag and David Gluckman — Marketplace disruption is reshaping health care in the U.S., with headline-grabbing mergers and the formation of new companies. These moves are breaking down traditional silos in health care. And further change can be expected, as calls grow louder for better health-care value for the dollar. Four trends are driving the shift: an ongoing movement toward value-based payments; improved health-care data analytics; innovations in medical science; and increasing demand from consumers for greater convenience and value. These trends, along with corporate tax reform, will continue to foster mergers and other shifts that blur the lines between previously distinct segments of the health care industry. In turn, competitive new companies that can provide better, less expensive and more convenient health care will only increase the pressure for systemwide change.

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Prescription Drugs

  • State Solutions to Bring Down Drug Prices Face Steep Resistance from Drug Industry  FierceHealthcare by Paige Minemyer — There are plenty of ways to tackle rising drug prices, experts say—if they aren't blocked by industry first. Even as states increasingly take legislative action on drug prices, they have been blocked by pharmaceutical companies in court, said Jane Horvath, senior policy fellow at the National Academy for State Health Policy, at a forum hosted in Washington, D.C., by Kaiser Permanente's Institute for Health Policy. "There's a whole constellation of problems or hurdles to be overcome, which is why state policy around drug prices is looking insane and just crazy," Horvath said. Drug prices have been a central issue for health agencies under the Trump administration, with both President Donald Trump and Department of Health and Human Services Secretary Alex Azar putting a focus on the problem. The White House has laid out a plan to reduce drug costs, but experts are skeptical that it will be effective in light of the potential legal hurdles.

  • Drug Companies Get Tax Windfall, but They're Not Reducing Prescription Prices  USA Today by Andy Slavitt, Opinion columnist — Drug prices are a top pocketbook issue for Americans. President Trump understood that and campaigned on promises to bring down the cost of prescriptions. You’d think the massive tax cut he signed into law in December would be the perfect opportunity for drug companies to take some of their windfall and bring down those prices. But a new analysis shows that so far, you'd be wrong. A study, based on 4th quarter earnings calls, press releases and public statements, shows that in its early days, the new tax law has been almost entirely a boon to shareholders. Five drug companies alone have announced $45 billion in stock buybacks — accounting for 21 percent of the largest stock buybacks announced this year. 

  • CVS to Compare Drug Prices at the Pharmacy Counter  Forbes by Bruce Japsen — CVS Health will introduce a new effort to help customers compare drug prices for more transparency at its pharmacy counters, ratcheting up pressure on the pharmaceutical industry and drug costs. Pharmacists have long advised patients on whether a drug is covered by insurance or whether a cheaper generic is available. But CVS admits a more robust effort is needed by its drugstores and pharmacy benefit business at a time an increasing number of patients are paying more out of their pockets for drugs as high deductible plans have proliferated. CVS said Wednesday its new "CVS Pharmacy Rx Savings Finder" allows for a more seamless process, reviewing the patient's "prescription regimen, medication history and insurance plan information."

  • Drug Company 'Shenanigans' to Block Generics Come Under Federal Scrutiny New York Times by Robert Pear - Trump administration officials, seeking ways to lower drug costs, are targeting pharmaceutical companies that refuse to provide samples of their products to generic drug companies, making it impossible to create inexpensive generic copies of a brand-name medicine. Dr. Scott Gottlieb, the commissioner of the Food and Drug Administration, said recently that drugmakers must "end the shenanigans" that prevent competing products from reaching the market. Federal officials said they were focusing on the anticompetitive practices of brand-name drug makers under the impetus of a vow by President Trump to hold down prices set by drug companies, which he has said are "getting away with murder." The Congressional Budget Office estimates that the legislation would save the federal government $3.8 billion over 10 years, mainly because Medicare, Medicaid, and other health programs would spend less on prescription drugs. Savings for consumers and private health insurance plans could be much greater.

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Opioid Epidemic

  • The Opioid Crisis: Drug Executives to Testify Before Congress About Their Role in Distributing Powerful Painkillers  Washington Post by Katie Zezima and Scott Higham — Current and former executives with the pharmaceutical distributors that are accused of flooding communities with powerful prescription painkillers have been summoned to testify before Congress about their role in the U.S. opioid epidemic. The hearing, scheduled for May 8 before a House Energy and Commerce Committee oversight panel, has the potential to be a defining moment for the pharmaceutical industry, much like when tobacco executives were called to testify before Congress in 1994. The pharmaceutical executives are expected to face tough questions under oath about why their companies pumped so many highly addictive pain pills into West Virginia and other states, fueling what has become the deadliest drug crisis in U.S. history.

  • Judge Schedules Trial in Massive Opioid Lawsuit  The Hill by Peter Sullivan — A federal judge in Ohio has set a trial date for part of a massive combined lawsuit against drug manufacturers and distributors over the opioid epidemic. Judge Dan Polster on Wednesday set a March 2019 trial date for cases from three of the cities and counties that are suing drug companies. Those cases would be the first of hundreds brought under Polster's review to see a trial and could serve as "bellwethers" that help both sides test the waters. The cases are being closely watched to see if they produce a settlement that forces changes meant to fight the opioid epidemic. Polster said in January that he wanted to take actions that would stem the tide of the crisis. Polster said Wednesday that while he wants a settlement, the companies have "asserted forcefully that they cannot reach final settlement without litigating certain matters," according to Reuters.

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Editor

Editor: Peter Van Vranken

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http://www.commonwealthfund.org/publications/newsletters/headlines-in-health-policy/2018/apr/apr-16-2018