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Lauren Sullivan had been trying to appeal UnitedHealth’s initial refusal of the drug for her 21-month-old daughter, Daryn. The girl was running out of time to receive the treatment before her second birthday in October, when the drug has to be administered. The company also approved claims for three other patients. In other news, UnitedHealth beats expectations for the quarter, prompting company to boost earnings guidance.
Presidential hopefuls Sen. Bernie Sanders (I-Vt.) and former Vice President Joe Biden would take separate paths on how to address health care, with Sanders going for an overhaul approach and Biden favoring building on what exists. The two philosophies have come to divide a crowded pack of Democrats as the election season starts kicking into gear, and in the past few days Sanders and Biden have been publicly swiping at each other over the issue. Meanwhile, governors are particularly worried about candidates’ rhetoric about getting rid of private insurers.
Prosecutors say Joseph Prince, a former Veterans Affairs employee, exploited his position of trust to steer patients to seven different home health agencies that subsequently kicked back money to Prince and his family.
Although the guidance shifts costs to insurers, the companies have actually been pushing for the flexibility to begin providing coverage for those treatments, such as glucose or blood-pressure monitors, because people who don’t get ongoing treatment for a disease can have their condition worsen, leaving insurers paying even more for their care.
Lawmakers are gung-ho about addressing the issue of surprise medical bills, but the central question of who covers the costs instead remains. The debate is drawing out major health care players to push for the best outcome in the fight. On Wednesday, the House Energy and Commerce Committee approved its version of the legislation.
The “Cadillac tax,” which never went into effect, was intended to help control costs by putting a brake on the value of health insurance plans and avoid having insurers and employers shifting more costs to policyholders. Its implementation has been delayed for years, and House Democrats voted to repeal it once and for all. It still needs to go to the Senate, but in all likelihood the upper chamber will eagerly follow suit, as Republicans didn’t like the provision.
House Speaker Nancy Pelosi (D-Calif.) wrote a letter to Treasury Secretary Steven Mnuchin requesting $22 billion over two years to cover the cost of a revamp of the VA health-care program signed into law last year. She said that the funding for the program should be in addition to the equal increases she is seeking for nonmilitary and military funding. Lawmakers are trying to get an overall deal done before the House leaves for August recess.
The tax, which has been repeatedly delayed, would have been on the most generous and expensive employer health-insurance plans. But lawmakers are under pressure from labor unions to kill it.
The Department of Veterans Affairs sent out one rejection letter to each of the 208,272 applicants in 2016 before purging them from the backlog, despite requests that the agency send an additional letter.
Some medical experts see any success from the procedure as nothing more than a placebo effect. But as doctors seek different ways to address pain in the midst of an opioid crisis, HHS Secretary Alex Azar says acupuncture is worth exploring.
Former Vice President Joe Biden made a similar vow to voters at an AARP/Des Moines Register forum that then-President Barack Obama made as he was touting the health law. The echo from years past highlights Biden’s strategy of building upon the system already in place that has only grown in popularity in recent years. But it could put him out of step with the mood of the party. “Politically, Biden is trapped by his old job,” said Scott Jennings, an appointee in former President George W. Bush’s administration.
All four of the participants at the first of five presidential candidate forums that AARP and the Des Moines Register are sponsoring in Iowa favored a more moderate expansion of health care coverage over progressive “Medicare for All” proposals. Monday’s forum in Des Moines featured former Vice President Joe Biden, Sens. Cory Booker (N.J.) and Amy Klobuchar (Minn.) and former Colorado Gov. John Hickenlooper.
The Tennessean looks at the dramatic negative effects the paperwork system — which has now been replaced — had on the state’s children. Medicaid news comes out of Indiana, New York and Montana, as well.
The American Hospital Association spoke out in support of CMS’ decision to hold off on releasing the ratings, which have long provoked push back from the industry over the methodology the agency uses.
Judge Patty Schwartz, writing for the 3rd U.S. Circuit Court of Appeals in Philadelphia, said the Affordable Care Act plainly states that women must be provided preventive health services. The Trump administration’s rules that would allow employers to deny workers insurance coverage for birth control due to religious or moral objections sparked an immediate court challenge when rolled out in November.
Republican lawmakers are taking a new look at the options to replace the health law in case the court challenge working its way toward the Supreme Court is successful. The party has long struggled to craft replacement legislation, and had in previous months abandoned efforts to do so.
Former Vice President Joe Biden rolled out his health plan Monday morning following a weekend of trading jabs over “Medicare for All” with Sen. Bernie Sanders (I-Vt.). Biden’s plan would include the creation of a public option as well as the elimination of the existing cap on health care tax credits to make coverage more affordable. The proposal solidifies Biden’s stance as one the health law’s biggest defenders in a race where health care has become a dividing topic between the candidates.
President Donald Trump’s drug pricing strategy received its second major blow this week on the announcement that the proposal to eliminate drug rebates in Medicare and Medicaid plans will be withdrawn. In January, HHS Secretary Alex Azar said that the proposal had “the potential to be the most significant change in how Americans’ drugs are priced at the pharmacy counter, ever.” But the changes met significant pushback from insurers and hospitals who worried the proposal wouldn’t force drugmakers to lower prices and would likely see higher profit margins from it. Looking forward, Trump will be left considering ideas that are more popular with progressives than his party.
A pricey treatment offered hope to a family with a daughter with a rare defective gene that causes spinal muscular atrophy. The therapy must be administered before the age of 2, but the family is locked in a fight with its insurance company over coverage. In other pharmaceutical news: the use of PrEP in the fight against AIDS, Massachusetts’ governor’s drug plan, clinical trial data, and more.
California already covers low-income children regardless of immigration status, but now has become the first state in the country do go further to young adults. Meanwhile, the Democratic debate thrust the issue into the national spotlight after the candidates showed support for expanding health care coverage for everyone in the country. Meanwhile, border arrests are finally dropping, but still remain high.