What’s New in Health Care Reform: Oct. 18

The Week in Review provides an overview of the past week’s top health care content, including industry news and trends, Mayo Clinic and Mayo Medical Laboratories news, and upcoming events.


Cascade of Costs Could Push New Gene Therapy above $1 Million Per Patient

Outrage over the high cost of cancer care has focused on skyrocketing drug prices, including the $475,000 price tag for the country’s first gene therapy, Novartis’ Kymriah, a leukemia treatment approved in August. But the total costs of Kymriah and the 21 similar drugs in development—known as CAR T-cell therapies—will be far higher than many have imagined, reaching $1 million or more per patient, according to leading cancer experts. The next CAR T-cell drug could be approved as soon as November. Via Kaiser Health News.

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Gov. Dayton Signs Agreement for "Reinsurance" Program

Gov. Mark Dayton signed an agreement with the federal government for the state’s new “reinsurance” program, which discounts premiums by about 20% next year from where they otherwise might fall in Minnesota’s individual market. In a letter to federal officials, however, Dayton said he still objects to related to cuts in federal funding for the MinnesotaCare health insurance program. About 166,000 state residents buy health insurance in the individual market, which primarily serves people under age 65 who are self-employed or don’t get coverage from their employer or a government program. Via Star Tribune.

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The Value of Hospitals' Tax Exemptions

The American Hospital Association released a report last week that said the benefits not-for-profit hospitals provide to their local communities far outweigh foregone federal tax revenue. But experts say the AHA's report has flaws and omissions that exaggerate hospitals' community roles and understate the power of their tax exemptions. Via Axios.

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18 States Sue over Trump-Halted Obamacare Payments

A new multi-state lawsuit has been announced to stop President Trump from halting key Obamacare payments to insurers. Eighteen states and Washington, D.C., signed onto the lawsuit filed in federal court in California, according to Sarah Lovenheim, a spokeswoman for California Attorney General Xavier Becerra (D). Via The Hill.

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End to Health Care Subsidies Puts Congress in a Tight Spot

President Trump’s decision to cut off critical payments to health insurance companies ratcheted up the pressure on Congress on Friday to take action to protect consumers from soaring premiums, while also adding a combustible new issue to negotiations to avert a government shutdown this year. Mr. Trump’s move could cause chaos in insurance markets, sending insurers fleeing from the Affordable Care Act’s marketplaces, raising the federal government’s costs, and pricing out some consumers. It came just hours after he signed an executive order that also undermined the health law by encouraging the development of lower-cost insurance policies not subject to the Affordable Care Act’s rigorous coverage standards. Via NY Times.

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Trump Will Scrap Critical Obamacare Subsidies

Cutting off the payments to insurers, which could happen almost immediately, is likely to provide another jolt to Obamacare markets. President Donald Trump plans to cut off subsidy payments to insurers selling Obamacare coverage in his most aggressive move yet to undermine his predecessor's health care law. The subsidies, which are worth an estimated $7 billion this year and are paid out in monthly installments, may stop almost immediately since Congress hasn’t appropriated funding for the program. Via Politico.

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Hospital Group Warns Trump's Executive Order Could Weaken Insurance Markets

The largest hospital association warned that an executive order signed by President Trump could destabilize insurance markets and make coverage unaffordable for people with pre-existing conditions. Via The Hill.

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Most ACOs in Next Generation, Pioneer Models Saved Money, Earned Payments for 2016

The Next Generation and Pioneer ACO models earned payments for 11 out of 18 health systems participating in Next Generation in 2016 and for 6 out of 8 in Pioneer. Seven Next Generation ACOs lost money, according to the Centers for Medicare and Medicaid Services. Three had dropped out in 2016 due to financial targets they said were set too high to earn savings. Via Healthcare Finance.

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Another Last-Ditch Effort to Tackle Obamacare Stalls within Hours of Its Release

Yet another last-ditch effort to tackle the nation’s health-care system stalled within hours of its release by a bipartisan pair of senators, with President Trump sending mixed signals and Republicans either declining to endorse the proposal or outright opposing it. The week began on Capitol Hill with a renewed sense of urgency to craft legislation following Trump’s decision last week to end key payments to health insurers that help millions of lower-income Americans afford coverage but that the president argued were illegal under the Affordable Care Act. Via Washington Post.

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With ACA in Limbo, Insurers Brace for Drop in Enrollment

With enrollment for 2018 Affordable Care Act health-insurance plans starting in just two weeks, insurers are bracing for a drop-off among consumers put off by higher rates, confusion about the law’s standing and a shorter window to choose coverage. Via Wall Street Journal.

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andytofilon

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.