Latest Morning Briefing Stories

Officials Remain Divided Over Policy, Legal Issues As Trump Administration Pushes Toward Medicaid Block Grants

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CMS Chief Seema Verma is finalizing a plan to allow states the flexibility to convert their Medicaid programs into block grants. While supporters of the idea say that gives states the freedom to find cost-saving measures, critics warn that it incentivizes states to cut coverage for a vulnerable population. In other Medicaid news: care coordination, coverage for kids, minimum wage increases, and managed care companies.

Wave Of State-Level Bills Restricting Medical Care For Transgender Teens Reignites Polarizing Debate On Issue

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More than half a dozen states are considering legislation that would penalize doctors for performing certain treatments for transgender patients. The speed and number of state bills has mobilized activists, suicide prevention groups and civil rights organizations. In 2018, the American Academy of Pediatrics released a policy statement that recommended giving youths “access to comprehensive gender-affirming and developmentally appropriate health care,” while noting the benefits and risks of using hormones that delay puberty.

Insurers To Invest $55M In Making Cheaper Versions Of Expensive Generic Drugs In Sign Of Growing Frustration

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The Blue Cross Blue Shield Association and 18 of its member organizations are teaming up with Civica Rx, a nonprofit that is already selling drugs used in hospitals to health systems. The move comes not long after California Gov. Gavin Newsom floated a similar proposal, in which the state would contract with outside manufacturers to sell generic drugs under a California label.

Trump Hints He May Be Open To Cutting Medicare, Safety-Net Programs In Shift From 2016 Campaign Promises

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“At the right time, we will take a look at that. You know, that’s actually the easiest of all things, if you look,” President Donald Trump said in response to a question whether cuts to programs like Medicare and Social Security were on the table. The statement was a departure from the last election when Trump tapped into the popularity of the two programs while wooing voters.

Guidance To Allow States To Request Block Grant Waivers For Medicaid Programs Expected Soon

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Approving state waivers to change Medicaid funding to block grants would be among the Trump administration’s most controversial moves to reshape Medicaid. While supporters of block granting say it gives states more flexibility, critics warn that it creates incentives for states to cut aid for its most vulnerable populations. Meanwhile, Medicaid expansion advocates are frustrated by the last remaining red-state holdouts.

A Record That Keeps Getting Broken: Hemophilia Treatment Poised To Become Most Expensive Drug In World

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The gene therapy, which isn’t officially priced yet, was extremely successful in trials. Its maker says that insurers seem on board with paying somewhere between $2 million and $3 million for the drug, which would break the previous record held by Novartis’ spinal muscular atrophy drug. Experts warned when Novartis’ drug was approved at its $2.1 million price that it was setting a bad precedent. In other pharmaceutical news: more updates from the JP Morgan conference, the science behind the Ebola vaccine, a diabetes pill, and more.

Betting On Medicare Advantage Pays Off Big For UnitedHealth

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UnitedHealth executives said they added 370,000 Advantage members during the open enrollment period that ended Dec. 7, which reflects growth of about 140% over the prior annual enrollment period. As the program grows in popularity, insurers clamor for a piece of the lucrative marketplace.

Health Care Takes Back Seat To Foreign Policy, Gender Politics At Democratic Debate As Candidates Cover Well-Trodden Ground

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Although the domestic agenda was somewhat anchored by discussion of health care, the topic didn’t take center stage like at previous debates. Sen. Bernie Sanders (I-Vt.) focused on the cost of the status quo while moderates like Sen. Amy Klobuchar (D-Minn.) made the argument that debating “Medicare for All” is a pointless since many in Congress don’t support it.

Experts Debunk Trump’s Claims That He Saved Pre-Existing Conditions Coverage

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President Donald Trump defended his administration’s efforts to protect health coverage for Americans in response to presidential hopeful Michael Bloomberg’s ads, but fact checkers and other experts were quick to point out that Trump has gone to great lengths to weaken the health law and its popular provisions throughout his presidency. “That tweet is so far inconsistent with the direction of their policy push,” said Linda Blumberg, a health policy analyst at the Urban Institute. “It’s just astounding to me.”

Supreme Court Agrees To Hear Potentially Monumental Case Over Extent To Which States Can Regulate PBMs

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Pharmacy benefits managers, the controversial middlemen in the drug pipeline, are a favorite target to blame for higher prescription drug costs. A Supreme Court decision on how much oversight states can place on PMBs could send shock waves through the debate over health care costs. In other pharmaceutical news: genetic testing and proprietary data, lax oversight of the 340B drug program, a startup with the possible answer to high drug costs, and more.

Appeals Court Judges Seem Disinclined To Let Insurers Recoup Loses From Cut To Cost-Sharing Reduction Payments

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The federal government is arguing that insurers received increased subsidies when they raised premiums, which more than compensated their losses. Judges in the U.S. Court of Federal Claims have so far sided with insurers and ruled that their strategies to mitigate losses from CSR payments do not affect their eligibility for repayment. Meanwhile, states report their health law enrollment numbers.