What’s New in Health Care Reform: July 13


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.

Obama Offers Ways to Improve His Health Care Law

After defending the Affordable Care Act in all its intricacies for six years, President Obama proposed ways to improve it on, saying that Congress should provide larger subsidies for private health insurance and create a public plan like Medicare to compete with private insurers in some states. At the same time, he accused the pharmaceutical industry of trying to protect its profits by opposing any constraints on drug prices. Via NY Times.

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Obama Renews Call for a "Public Option" in Federal Health Law

President Obama called on Congress to revisit the controversial idea of providing a government-run insurance plan as part of the offerings under the Affordable Care Act. What's been described as the "public option" was jettisoned from the health law in 2009 by a handful of conservative Democrats in the Senate. Every Democrat's vote was needed to pass the bill in the face of unanimous Republican opposition. But in a "special communication" article published on the website of JAMA, the American Medical Association's top journal, the president says a lack of competition among insurance plan offerings in some regions may warrant a new look. Via NPR. 

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ACA Risk Adjustment Program Endangers Some Exchange Plans

The latest data on the Affordable Care Act's risk-adjustment program have some small health insurers up in arms. Many are demanding the federal government halt the payments and make immediate dramatic changes to the program or risk having more health plans shut down during a presidential election year. Via Modern Healthcare.

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Why Hospitals Are So Mad about Medicare's Proposed Site-Neutral Payment Policy

Hospitals are livid about the Obama administration's plans to eliminate their Medicare payments for services at new off-campus outpatient departments, saying it ignores the intent of Congress and will limit access to care. Via Modern Healthcare.

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Obama Administration Eases Restrictions on Doctors Who Treat Opioid Addiction

The Obama administration is making it easier for people addicted to opioids to get treatment. Health and Human Services Secretary Sylvia Burwell announced new rules to loosen restrictions on doctors who treat people addicted to heroin and opioid painkillers with the medication buprenorphine. Doctors who are licensed to prescribe the drug, which is sold mostly under the brand name Suboxone, will be allowed to treat as many as 275 patients a year. That's almost triple the current limit of 100, and HHS estimated that as many as 70,000 more people may have access to the drug as a result. Via NPR.

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House HHS Funding Bill Would Provide $33.3 Billion for NIH, Defund Obamacare

The House Appropriations Committee is proposing a $1.25 billion increase in funding for the National Institutes of Health and $525 million increase to address the opioids crisis in fiscal year 2017. The Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will mark up the related funding bill, but it’s unclear how far the bill will go. A continuing resolution is looking more and more likely as the time left in the fiscal year that Congress is in session is shrinking. Via Morning Consult.


HHS Spending Zika Money Slowly, Amid Big Funding Battle

The Obama administration has so far distributed only about one-sixth of the unspent Ebola funding that it diverted to combat the Zika virus, according to administration officials. The White House in April diverted $589 million to the Zika virus amid congressional squabbling over approving new emergency funding. Since then, the administration has distributed $112 million, according to HHS figures shared with POLITICO. Another $100 million is expected to be distributed to states soon and “much” of the remaining funding will be sent out this month and next, according to HHS. Via Politico.

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Insurers’ Spending on Costly Meds Soared from 2003–2014

The latest study of medicine prices finds U.S. insurers' spending on expensive prescription drugs nearly quadrupled from 2003 through 2014, when the number of such prescriptions filled tripled. Spending on expensive "specialty" drugs by commercial insurance plans jumped from 11% of spending on all prescriptions filled in 2003 to 43% in 2014, according to the study, published by the journal Health Affairs. Via AP.


ACA Enrollees Are Less Healthy, Uninsured Are Healthier

During the first year of Obamacare’s implementation, the individual insurance market became less healthy while the uninsured and Medicaid populations became healthier, according to a new analysis. A Health Affairs data analysis underscores the often stated observation that the Affordable Care Act has brought sicker, more expensive enrollees into the individual marketplace while healthier people have tended to resist enrollment. Via Morning Consult.

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Insurers Rally to Defend Obamacare Risk Payments

Insurers are ramping up lobbying to defeat legislation that would limit their payments under one of the 2010 health law's stabilization programs, according to congressional staff and outside experts. The bill (S 2803), from Nebraska Republican Sen. Ben Sasse would slash in half the Department of Health and Human Services general management budget, unless the agency pays certain funds from the so-called reinsurance program to the Treasury Department. Until now, the agency has prioritized its payments to insurance companies and not yet paid into the Treasury, a practice it has justified under the health law (PL 111-148, PL 111-152). Via Roll Call.

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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.