What’s New in Health Care Reform: May 25

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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.


House Committee Chairs Argue Administration Should Share Obamacare Documents After Judge’s Ruling

Two House committee chairmen again called on the Obama administration to provide documents related to the Affordable Care Act’s cost-sharing reduction program. Ways and Means Committee Chairman Rep. Kevin Brady (R-Texas) and Energy and Commerce Committee Chairman Fred Upton (R-Mich.) sent letters to the Department of Health and Human Services, Department of the Treasury and Office of Management and Budget asking them to produce subpoenaed documents related to the cost-sharing reduction program, which the administration has not produced because of the House-sought lawsuit over the program. Via Morning Consult.

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Medicaid Plans Succeed in Obamacare as Others Struggle

Smaller insurers with experience in Medicaid, such as Centene Corp. and Molina Healthcare, are outperforming the broader insurance industry on the federal health exchanges. Their success is putting a spotlight on their business model as the Obama administration and other insurers seek to stabilize the fledgling individual market. If Medicaid-like plan features become the norm, consumers and medical providers would be substantially affected. Such plans are often popular in the exchanges for their low premiums, but consumers have criticized limits on their access to medical providers such as doctors. And physicians fault the plans for low reimbursement rates. Via Roll Call. 

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Medicare Returning to an Old-Fashioned Idea: House Calls

Looking for ways to save money and improve care, Medicare officials are returning to an old-fashioned idea: house calls. But the experiment, called Independence at Home, is more than a nostalgic throwback to the way medicine was practiced decades ago when the doctor arrived at the patient's door carrying a big black bag. Done right and paid right, house calls could prove to be a better way of treating very sick, elderly patients while they can still live at home. Via USA Today.

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Proposal To Reduce Medicare Drug Payments is Widely Criticized

An Obama administration proposal to reduce Medicare payments for many prescription drugs has run into sharp bipartisan criticism, suggesting that it is easier to diagnose the problem of high prices than to solve it. Patients’ advocates have joined doctors and drug companies in warning that the federal plan could jeopardize access to important medications. Every member of the Senate Finance Committee — 14 Republicans and 12 Democrats — and more than 300 House members have expressed concern. Via NY Times.

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Poll: Most Individual Insurance Customers Bought Through Exchanges

Nearly two-thirds of people who do not purchase health insurance through the group market bought their coverage on the Affordable Care Act exchanges, according to a newly-released Kaiser Family Foundation poll. Via Morning Consult.

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GOP Lawmakers Unveil Obamacare Replacement Bill

Two Republican lawmakers introduced an alternative to Obamacare as the House develops its own health care plan. The bill from Rep. Pete Sessions (R-Texas) and Sen. Bill Cassidy (R-La.) does not fully repeal Obamacare, a notable departure from the GOP’s long-stated goal. But it would eliminate many central aspects of the Affordable Care Act, including the mandates for individuals to have coverage and for employers to provide it, as well as requirements for what an insurance plan must cover. Via The Hill.

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Telehealth Increasingly Used for Mental Health Care

The rapid growth of telehealth services for mental and behavioral care means employers should consider the rewards and risks associated with this delivery of health care, particularly when it comes to privacy and state laws. Via BNA.

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Trying to Get Jump on Zika Preparations with Money in Limbo

Beg, borrow, and steal: Zika preparation involves a bit of all three as federal, state, and local health officials try to get a jump on the mosquito-borne virus while Congress haggles over how much money they really need. With that financing in limbo, health officials are shifting resources and setting priorities - and not just in states where mosquitoes are starting to buzz. All but six states so far have seen travel-associated cases of Zika. Via AP.

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How a Deadly Tropical Virus Became Another Washington Mess

The Zika debate is caught up in election year politics and general GOP opposition to emergency spending. But there is another huge factor at play with Zika. Many congressional Republicans say they feel burned by the Obama administration’s response to the Ebola outbreak in 2014. In hindsight, the emergency response to that crisis was overfunded, they say, and now the White House is reluctant to reallocate all of the leftover money. Congress doesn't want to give another blank check on Zika. Via Politico.

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Moving Patient Payment Upfront

Patients carrying high-deductible insurance plans under the Affordable Care Act presented Ascension Health's leadership with a walk-the-walk moment last month. Hundreds of patients, many newly insured, were leaving Ascension Health's hospitals and other facilities drowning in debt from the deductibles not covered by their plans, said Rhonda Anderson, chief financial officer of the nation's largest not-for-profit health system. 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.