What’s New in Health Care Reform: May 17

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.

Gov’t Report: Efforts to Reduce U.S. Uninsured Stalled in 2016

After five consecutive years of coverage gains, progress toward reducing the number of uninsured Americans stalled in 2016, according to a government report that underscores the stakes as Republicans try to roll back Barack Obama’s law. The Centers for Disease Control and Prevention estimated that 28.6 million people were uninsured last year, unchanged from 2015. The uninsured rate was 9 percent, an insignificant difference from 9.1 percent in 2015. Via AP.

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CMS to Let Small Businesses Bypass Obamacare Marketplace

The Trump administration plans to let small businesses bypass the Affordable Care Act’s online marketplace to get health insurance for their employees. Obamacare was meant to offer better insurance options for small businesses through the Small Business Health Options Program while rewarding companies with tax credits for offering insurance to their employees. But enrollment in SHOP plans fell drastically below expectations. Just 230,000 Americans were insured in the plans as of January, less than one-tenth of the Congressional Budget Office’s estimate of 4 million covered by this year. Via Morning Consult.

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Policymakers Face Pressure to Act on Drug Pricing

A proposal that would open the door for the import of low-cost prescription drugs from Canada was defeated at a Senate markup, but the proposal is unlikely to be gone for good. Lawmakers from both parties seem to want to demonstrate concern about drug prices to voters. The administration also appears interested in addressing the issue, with Health and Human Services Secretary Tom Price holding listening sessions with patient groups and think tanks in recent weeks. Via Roll Call.

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Senate Panel Rejects Bid to Ease Drug Imports from Canada

A Senate panel rejected a Democratic effort to make it easier for Americans to purchase medications from Canada, where prescription drugs are typically sold at significantly cheaper prices than in the United States. The Senate Health, Education, Labor, and Pensions Committee voted 13-10 along mostly party lines to kill the proposal, which was offered by Sen. Bernie Sanders (I-Vt.) as an amendment to bipartisan legislation that would reauthorize Food and Drug Administration programs. Via Morning Consult.

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Health Care Industry Finds a More Receptive Senate

The Trump administration and House Republicans mostly ignored hospitals, doctors, some health insurers, and other health care industry players in the push to pass the American Health Care Act. But now that the more moderate Senate is handling the potential Affordable Care Act repeal effort, some health care groups are finding a seat back at the table. Via Axios.

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CBO Score Release Timeline Leaves Senators Waiting

The Congressional Budget Office said it would release its analysis of the House-passed health care bill early in the week of May 22, leaving Republican senators with their hands tied as they seek to craft their own version of the American Health Care Act. The Senate bill must achieve the same deficit savings as the measure the House approved last week, according to the budget resolution rules, meaning senators will likely have to wait several weeks to make final decisions on their bill to repeal and replace the Affordable Care Act. Via Morning Consult.

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Aetna Exiting All ACA Insurance Marketplaces in 2018

Aetna will complete its withdrawal from Affordable Care Act insurance exchanges for 2018, announcing that lingering financial losses and uncertainty about the marketplaces’ future was prompting it to exit two final states. According to an Aetna spokesman, the insurer will not sell individual health plans next year in Delaware or Nebraska. Its announcement came a week after the company said it would stop offering ACA health plans in Virginia in 2018 and a month after it said it would leave Iowa. The cascade of state-by-state decisions represents a stark turnabout for the nation’s third-largest insurer, which initially entered 15 states’ marketplaces but last summer decided to slash its 2017 participation to just four. Via Washington Post.

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FDA Proposes that Doctors Learn about Acupuncture for Pain Management

Chiropractors and acupuncturists who have lobbied for a bigger role in treating pain have won a preliminary endorsement from federal health officials. The Food and Drug Administration released proposed changes to its blueprint on educating health care providers about treating pain. The guidelines now recommend that doctors get information about chiropractic care and acupuncture as therapies that might help patients avoid prescription opioids. Via STAT.

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Blue Cross Blue Shield Plans Will Offer Free Lyft Rides

The Blue Cross and Blue Shield Association is partnering with ride-sharing company Lyft to help people who may not have reliable transportation get to their routine doctors' appointments. How it works: The service will launch in the fall and will be free for people who have commercial Blue Cross and Blue Shield coverage through their jobs. It's possible the service could be extended to seniors on Medicare Advantage and people with Affordable Care Act plans. Via Axios.

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A Whistle-Blower Tells of Health Insurers Bilking Medicare

When Medicare was facing an impossible $13 trillion funding gap, Congress opted for a bold fix: It handed over part of the program to insurance companies, expecting them to provide better care at a lower cost. The new program was named Medicare Advantage. Nearly 15 years later, a third of all Americans who receive some form of Medicare have chosen the insurer-provided version, which, by most accounts, has been a success. But now a whistle-blower, a former well-placed official at UnitedHealth Group, asserts that the big insurance companies have been systematically bilking Medicare Advantage for years, reaping billions of taxpayer dollars from the program by gaming the payment system. Via NY Times.

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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.