What’s New in Health Care Reform: June 1


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.

I.R.S. Ruling Is Obstacle to Health Care Networks Promoted by Obama

In its recent ruling, the IRS denied a tax exemption sought by an accountable care organization that coordinates care for people with commercial insurance. The tax agency said the organization did not meet the test for tax-exempt status because it was not operated exclusively for charitable purposes and it provided private benefits to some doctors in its network. Via NY Times.

Read article

Lawmakers Urge CMS to Kill Home Health Care Demo

Over 100 House members are urging the Obama administration to withdraw a demonstration program that would require prior authorization before processing claims for home health care in an effort to prevent fraud. The lawmakers say the proposal would interfere with the patient-doctor relationship and would undermine efforts to move towards patient-centered care. The bipartisan letter was led by Reps. Tom Price (R-Ga.) and Jim McGovern (D-Mass.), and was signed by 116 lawmakers. Via Morning Consult. 

Article No Longer Available

NIH Funds Biobank to Support Precision Medicine Initiative Cohort Program

As part of President Obama’s Precision Medicine Initiative (PMI), the National Institutes of Health will award $142 million over five years to the Mayo Clinic, Rochester, Minnesota, to establish the world’s largest research-cohort biobank for the PMI Cohort Program, a longitudinal research study that aims to enroll 1 million or more U.S. participants to advance precision medicine. The award will support the collection, storage, and distribution for research use of biological samples known as biospecimens. Laboratory analyses of the biospecimens, including chemical and genetic tests, will be a key component of the core PMI Cohort Program data set. These data, combined with other information provided by volunteers such as lifestyle and health questionnaires, medication history, electronic health records, physical exams, and environmental exposures and real-time physiology tracked through mobile health technologies, will help researchers study individual differences in health and disease. Via NIH.

Read article

Senators Working toward Mental Health Reform Vote before August Recess

Senators are still looking for a path forward on a floor vote for mental health legislation before the August recess, an effort that requires determining how to pay for the bill and how to deal with a controversial gun reform amendment. According to Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-Tenn.), Majority Leader Mitch McConnell has said that the bill could be brought to the floor this summer if it requires minimum floor time and few amendment votes. Via Morning Consult.

Article No Longer Available

Survey: Obamacare Customers Satisfied with Coverage

The percentage of Obamacare customers who say they are “very satisfied” with their health insurance coverage rose after the third open enrollment period, which ended in 2016, according to a survey released today by the Commonwealth Fund. Nearly half of the respondents (44%) said they were “very satisfied” with their plans, while 38% reported being satisfied with their 2016 coverage. The Commonwealth Fund surveyed enrollees between February and April of this year, its fourth survey tracking the health law’s progress. Via Morning Consult.

Article No Longer Available

Analysis Finds 2017 Premiums Rising, but Varies by State

Health insurance premiums are expected to rise for 2017, but by how much will vary by geographic area, an early analysis from Avalere Health finds. Premium rate requests were due to state insurance agencies earlier this month, and complete data is available in nine states so far, on which Avalere based their analysis—the first summary of the 2017 proposed rates. Proposed rates increased across all silver plans, but ranged from a 5% increase in Washington to a 44% increase in Vermont, the report says. Via Morning Consult.

Article No Longer Available

CMS Offers No-Risk Risk Contracts in Primary-Care Initiative

CMS is offering no-risk risk contracts to primary-care physicians in its efforts to drum up insurer interest in administering a far-reaching experiment designed to change the way primary care is delivered to as many as 25 million Americans. The latest wrinkle in the CMS' Comprehensive Primary Care Plus initiative, announced last month, has left many of the insurers the agency wants to see participating in the program scratching their heads. Via Modern Healthcare.

Read article

Local Health Departments Brace for Funding Loss Amid Zika Standoff

Health departments in all 50 states are scrambling to make up for the combined $45 million they will lose this summer if Congress fails to address a massive federal funding shortfall fighting the Zika virus. With Congress locked in a billion-dollar stalemate over Zika funding, the Centers for Disease Control and Prevention will be forced to eliminate emergency public health funding from as many as 62 health districts starting in July. Via The Hill.

Read article

CDC Urges Speed on Zika as House Moves to Negotiate Funding

The U.S. must act more quickly to protect pregnant women from birth-defect-causing Zika, a top health official said even as the House left town for its Memorial Day recess with no visible progress toward a congressional compromise on emergency funding to battle the virus. Via AP.

Read article

Va. Insurer’s Decision to Drop Bronze Plans Prompts Concerns

News that a CareFirst BlueCross BlueShield subsidiary will stop selling bronze level plans on the Virginia marketplace next year prompted some speculation that it could signal a developing movement by insurers to drop that level of coverage altogether. The reality may be more complicated and interesting, some experts said, based on an analysis of plan data. Via Kaiser Health News.

Read article


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.