What’s New in Health Care Reform: March 30

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What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.


Obamacare Enrollees May Be Sicker Than We Thought

People who enrolled in health insurance through the Affordable Care Act appear to be sicker than expected, according to new report from a major provider on the ACA exchanges. The findings support an observation that health experts have been seeing anecdotally for months. People who enrolled in individual health insurance plans after 2014 were less healthy and used more health care in 2014 and 2015 than those who were already enrolled in individual plans and those who receive insurance through their employers, according to a Blue Cross Blue Shield Association report. Via Morning Consult.


Obama Steps Up U.S. Effort To Fight Abuse of Heroin and Painkillers

President Obama, confronting a national epidemic of heroin and prescription drug abuse, met with recovering addicts, doctors, and law enforcement officials to underscore his determination to tackle a problem some critics say he left until too late in his administration. Via NY Times. 

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State Regulators, Small Health Insurers Unite in Campaign To Reform ACA's Risk Adjustment Program

A loose coalition of small health insurers and state regulators is stepping up efforts to reform the Affordable Care Act's risk adjustment program, warning that without changes it could force a slew of companies off of state exchanges or perhaps even out of business. Via SNL.

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Expanding Medicaid Increases Access To Mental Health, Substance Abuse Treatment, HHS Report Says

Approximately 1.9 million uninsured people with a mental illness or substance abuse disorder live in states that have not yet expanded Medicaid, according to a new report out from the Department of Health and Human Services. Via Morning Consult.


Hospitals Want Plans To Give Up More Data Before Getting Medical Claims Info

Hospitals want health insurance plans to give up more patient information before they can get access to Medicare and private sector claims data. The CMS should also release data from Medicaid and the Children's Health Insurance Program. In February, the CMS proposed a rule aimed at expanding access to analysis and data that could help health care industry stakeholders make business decisions that reduce costs and improve quality of care. Via Modern Healthcare.

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Mortgages For Expensive Health Care? Some Experts Think It Can Work

A Massachusetts Institute of Technology economist and Harvard oncologist have a proposal to get highly effective but prohibitively expensive drugs into consumers’ hands: health care installment loans. Writing last month in the journal Science Translational Medicine, the authors liken drug loans to mortgages, noting that both can enable consumers to buy big-ticket items requiring a hefty up-front payment that they could not otherwise afford. Some consumer advocates and health insurance experts see it differently. Via Kaiser Health News.

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Obama To Unveil Plan To Allow More Patients Access To Opioid Medication

The Obama administration will unveil a handful of measures intended to help curb the nation’s opioid epidemic, including a plan to permit doctors to double the number of patients who may receive a medication used to combat drug addiction. Currently, qualified physicians are allowed to prescribe the drug buprenorphine to 100 patients each, a cap set to ensure the safe use of a medication that can be addictive in and of itself. The administration’s plan would permit each doctor to treat 200 patients with the drug. President Obama will formally unveil the plan during a summit on prescription drug abuse in Atlanta, and the Department of Health and Human Services will issue the proposed rule. Via STAT.

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Budget Projects 12 Million ACA Enrollees, Smaller Deficit

The Congressional Budget Office is forecasting slightly smaller deficits than it did in January, after fully taking into account legislation passed in December. But the nonpartisan congressional scorekeeper still predicts an uptick in the federal deficit as a share of Gross Domestic Product this year for the first time since 2009. The new baseline is likely to be the scoring benchmark for legislation in Congress for the foreseeable future. Fortunately, Congress has only a couple of must-pass deadlines to handle ahead of the November general election, making the prospects slim for further legislation that would have major budgetary impacts. Via Morning Consult.


Under Obamacare, Government Insurance Thrives More Than Private Plans

According to the report, Medicaid and Children's Health Insurance Program enrollees will total 68 million people in 2016 – or 16 million more people than anticipated six years ago, when the law passed. In 2015, Medicaid enrollees increased by 3 million, and by 2026 an additional 6 million are expected to enroll. Via US News.

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Ready Or Not, The Bundled-Payment Challenge Is About To Start

The CMS Innovation Center deliberately selected markets of different sizes, and with varying spending trends for the mandatory pilot, said Amy Bassano, director of the agency's patient care- models group. Bundled payments, she said, “hold great promise,” but it's not yet clear how broadly the model can work. Federal officials selected joint replacements because the procedures are common for Medicare beneficiaries and cost the program $7 billion a year for hospital care. Via Modern Healthcare.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.