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.
With No Deal on Children's Health Plan, U.S. States Scramble for Plan B
CHIP provides health benefits to almost nine million children whose families earn too much to be eligible for Medicaid but cannot afford private insurance and has enjoyed bipartisan support since it was enacted in 1997. But this year, funding for the program expired on September 30. Congressional Republicans have tied its fate to other legislative battles, including attempts to repeal Obamacare and a newer effort to overhaul the U.S. tax system. Lawmakers had hoped to pass a five-year CHIP funding extension before they adjourned for the year. But aides in the House of Representatives and the Senate say they may not get to it until early 2018. Via Reuters.
White House Tamps down Expectations of Additional Opioid Funding This Year
White House press secretary Sarah Sanders told reporters she was unsure when Congress would fund new initiatives specific to addressing the opioid crisis. Sanders declined to guarantee that additional spending would be included in either a stopgap spending bill Congress is expected to approve in the coming week or a longer-term budget agreement many expect lawmakers to reach in January. Via STAT.
Medicare Fails to Recover Hundreds of Millions of Dollars in Lab Overcharges
As the nation’s bill for drug and genetic tests has climbed to an estimated $8.5 billion a year, there’s mounting suspicion among health insurers that some testing may do more to boost profit margins than help treat patients. Medicare has slashed fees for urine tests and tightened coverage of some genetic screens, which can cost Medicare $1,000 or more per person. Private insurers, who mostly have paid these bills without question, also are taking a more penetrating look at spending on the controversial lab work. Yet, getting these firms to repay Medicare and private insurers remains a formidable challenge. While some doctor-owned labs have dodged collection efforts for years, several testing firms deeply in debt to Medicare appear to have few assets to repay overcharges dating back years, court records show. Via Kaiser Health News.
Health Care Costs Push a Staggering Number of People into Extreme
There's new—and shocking—evidence about the toll that health care costs are taking on the world's most vulnerable. A joint report published in the journal Lancet Global Health by the World Bank and the World Health Organization estimates that each year more than 100 million people are pushed into extreme poverty in order to pay for health services—meaning that after covering their health bills, their income amounts to less than $1.90 a day. Another 800 million people are spending at least 10 percent of their household budget on health care. And 3.5 billion people—accounting for more than half of the world's population—are simply forced to go without most essential services. Via MPR.
Words Banned at Multiple HHS Agencies include "Diversity" and "Vulnerable"
The Trump administration has informed multiple divisions within the Department of Health and Human Services that they should avoid using certain words or phrases in official documents being drafted for next year’s budget. Officials at the Centers for Disease Control and Prevention, which is part of HHS, were given a list of seven prohibited words or phrases during a meeting Thursday with senior CDC officials who oversee the budget. The words to avoid: “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based,” and “science-based.” Via Washington Post.
How Blue States May Save Obamacare’s Markets
The looming demise of Obamacare’s individual mandate is spurring talks in a handful of blue states about enacting their own coverage requirements, as state officials and health care advocates fear repeal will roil their insurance markets. Republicans in Congress are poised to kill off the individual mandate in their sweeping tax overhaul, knocking out one of Obamacare's most unpopular features—but one that health experts have said is essential to making the law's insurance marketplaces function. Blue state officials, who have been working to protect their insurance markets from the Trump administration's efforts to dismantle the health law, are beginning to grapple with strategies for preserving coverage. Via Politico.
Pressure Builds on DEA to Stem Supply of Prescription Drugs, but at What Cost?
In a bland Northern Virginia office building nestled between a Costco and a freeway interchange, a dozen government scientists have spent the past year crunching numbers and making the following determination: In 2018, drug makers will be allowed to produce no more than 98,145 kilos of oxycodone, 38,047 kilos of morphine, and 1,342 kilos of fentanyl. The precise limits are set as part of a little-known process in which, every year, the Drug Enforcement Administration regulates the volume of controlled substances that can be produced in the United States. Via STAT.
FDA Officials to Target High-Risk Alternative Remedies
U.S. health officials plan to crack down on a growing number of unproven alternative remedies, focusing on products containing dangerous ingredients that have occasionally been linked to serious injury and death. The Food and Drug Administration issued a new proposal for regulating homeopathic medicines that have long been on the fringe of mainstream medicine. The agency plans to target products that pose the biggest safety risks, including those marketed for children or for serious diseases. Via STAT.
Drug Industry Spent Millions to Squelch Talk about High Drug Prices
Facing bipartisan hostility over high drug prices in an election year, the pharma industry’s biggest trade group boosted revenue by nearly a fourth last year and spread the millions collected among hundreds of lobbyists, politicians and patient groups, new filings show. It was the biggest surge for the Pharmaceutical Research and Manufacturers of America, known as PhRMA, since the group took battle stations to advance its interests in 2009 during the run-up to the Affordable Care Act. Via Kaiser Health New.
Medical Mergers in Minnesota Are on the Rise
The steady drumbeat of health care mergers is getting louder as more hospitals, clinics, insurers, and even pharmacies are banding together, all promising that bigger groups will provide better value. In Minnesota, a series of mergers is pumping up hospital and clinic systems that already dominate the top of the Star Tribune’s annual survey of the state’s largest nonprofit groups. Across the country, deals emerged just this month that would create three of the largest nonprofit hospital groups in the country—including two with more than twice the annual revenue of Minnesota’s famed Mayo Clinic, which ranks No. 2 among the state’s nonprofits. Via Star Tribune.