What’s New in Health Care Reform: Dec. 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.


Ryan Says Republicans to Target Welfare, Medicare, Medicaid Spending in 2018

House Speaker Paul D. Ryan (R-Wis.) said that congressional Republicans will aim next year to reduce spending on both federal health care and anti-poverty programs, citing the need to reduce America's deficit. “We're going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” Ryan said during an appearance on Ross Kaminsky's talk radio show. "Frankly, it's the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements—because that's really where the problem lies, fiscally speaking.” Via Washington Post.

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Sign-ups Pick up in Week Five of 2018 Obamacare Open Enrollment: U.S.

The number of people signing up for 2018 Obamacare plans picked up significantly during the fifth week of open enrollment, a U.S. government agency reported, but the number of participants appears to be falling short of last year’s numbers with just over a week of enrollment left. Via Reuters.

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Insurers on Pace to Record Obamacare Profits for First Time

After taking a beating for three years, health plans jacked up their rates for 2017, with the average premium on the most popular products rising more than 20%. That created sticker shock for many Obamacare customers while putting many insurers on pace to record profits this year for the first time, according to a POLITICO analysis of 31 regional Blue Cross Blue Shield plans, many of which dominate Obamacare markets in their states. Via POLITICO.

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The Way Over-the-Counter Drugs Are Regulated Is a Mess—and Congress Is Ready to Step in

The Food and Drug Administration has, for years, limited the amount of acetaminophen in any prescription painkiller to 325 milligrams a dose. Yet, walk into your local CVS and you’ll still find dozens of non-prescription painkillers containing 500, even 650, milligrams of the ingredient. The FDA also requires prescription codeine products to include a warning that they are unsafe for kids under 12. If your local drugstore carries it, you may find non-prescription codeine cough syrups that still list dosing information specifically for children. Via STAT.

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Cadillac Tax Is Sticking Point for Congress

Obamacare's "Cadillac tax" has emerged as a sticking point in bipartisan negotiations over delaying certain health-care taxes before the end of the year. Democrats are pushing to delay the “Cadillac tax” on high-cost health plans, which is despised by unions, but Republicans are pushing back and have resisted including the Cadillac tax in the package, sources say. Via The Hill.

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Obamacare Sign-ups Expected to Lag at End of Enrollment This Week

President Donald Trump’s nominee to oversee Medicare says he’s a fan of paying doctors and hospitals in new, potentially more efficient ways through experimental payment programs set up under Obamacare. The federal agency he’s been picked and that administers the programs to run just killed off three of them. Via Politico.

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Hospital Giants in Talks to Merge to Create Nation’s Largest Operator

Two major hospital systems are in talks about a possible merger that would create the largest U.S. owner of hospitals, as a series of deals shape up to further consolidate control of the health-care landscape. Ascension and Providence St. Joseph Health, both nonprofits, are talking about combining, according to people familiar with the discussions. A deal would create an entity of unprecedented reach, with 191 hospitals in 27 states and annual revenue of $44.8 billion, based on the most recent fiscal year. That would dethrone the nation’s largest pure hospital operator, HCA Healthcare Inc., which owns 177 hospitals and ended 2016 with $41.5 billion in revenue. Via Wall Street Journal.

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The Data Are in, but Debate Rages: Are Hospital Readmission Penalties a Good Idea?

A closely watched experiment in health care has unfolded over the last few years: Financial incentives for hospitals to reduce readmissions. It was a feature of the Affordable Care Act, and researchers are now assessing its impacts. But even as data have arrived, an impassioned argument has broken out among experts—looking at the same numbers, they have reached different conclusions about whether the policy is making Americans healthier. And, underscoring that disagreement is a deeper one—about what kind of evidence is needed before a health policy is enacted on a national scale. Via STAT.

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Medical Labs Sue Federal Government over Lower Payments

The medical lab industry's lobbying group, the American Clinical Laboratory Association, is suing the Department of Health and Human Services over a new reimbursement system that would drastically slash what Medicare pays for lab tests. The cuts would total about $670 million in 2018. Via Axios.

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Short-Term Funding Goes out to Some Health Centers

The Health Resources and Services Administration (HRSA) is sending some community health centers funding for January and February to help make up for the fact that Congress let a critical fund for them lapse. Health centers provide comprehensive care to millions of the nation’s most vulnerable, and about 25% have grant periods starting January 1. But Congress hasn’t renewed a major source of their federal funding, which expired September 30, causing health centers to worry about their long-term stability. Via The Hill.

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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.