Latest Morning Briefing Stories
Had the Supreme Court granted the House Democrats and states defending the law a quick court date, a ruling may have been issued before the 2020 elections that could have done damage to President Donald Trump and other Republicans. With the law’s growing popularity, it’s widely viewed as a winning topic for Democrats.
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.
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.
Nebraska wants to create a “prime” tier for those meeting work requirements and a more “basic” tier for those who aren’t. The model might allow the state to implement work requirements while alleviating courts’ concerns about people being dropped from enrollment. Medicaid news comes out of California, Missouri and Ohio, as well.
“I thought, ‘What if people out there don’t know that they have the right to tell those people to screw off?’” said Shaunna Burns, whose TikTok video helped a 22-year-old woman get her hospital bill reduced to zero.
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.
“Medicare for All” has been a hot topic throughout the 2020 Democratic primary race even as its popularity ebbs and flows. Now, as early voting states prepare to head for the polls, advocates hope to bolster sometimes-flagging support for the proposal.
A new study finds that coverage gains made in the early years of the health law are slipping. Researchers blame the shift largely on continued lack of coverage for adults in the 15 states that hadn’t expanded Medicaid.
Sen. Ron Wyden (D-Ore.) and Rep. Frank Pallone Jr. (D-N.J.) say Tennessee’s proposal would create a financial incentive for the state to cut coverage benefits for consumers, because it’s allowed to keep some amount of any of the unspent federal funds it’s awarded. Medicaid news comes out of Kansas and Ohio, as well.
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.
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.”
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.
Democrats had urged the Supreme Court to take up the case in the current term as it is unlikely otherwise to be decided upon before the 2020 elections. The Republicans, including the Trump administration, were given until Friday to respond. They said there’s no need to rush the case through the system.
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.
Under federal law, legal immigrants are eligible for government-funded health care. During arguments the three-judge panel questioned why President Donald Trump was allowed to overrule that legislation with his ban.
Gov. Laura Kelly (D-Kansas) campaigned on Medicaid expansion and has been pushing the Republican-controlled Legislature to do so since taking office. She has been wrangling with Kansas Senate Majority Leader Jim Denning on the deal, which would cover as many as 150,000 additional people.
The ministries promotes cheaper options than health plans offered under the ACA, but the groups don’t guarantee that they’ll actually cover the cost of medical bills when the need arises. As such alternatives gain in popularity, some states are starting to take a closer look.
“Just because you’ve been in jail for a short period of time, that shouldn’t automatically knock you off the [Medicaid] rolls,” said David Davis, the Democratic sheriff of Bibb County, Georgia. “You then have to go through enrollment all over again.” The disruption in enrollment can often negatively effect an already vulnerable population of people. Other Medicaid news comes from Iowa, Kansas, Missouri, Georgia, California and the South.
A new study found that in Canada, a country with a single-payer system, the cost of administrative work is $551 per person, a year. In America, it’s $2,497. Other news on costs looks at what states are –and aren’t– doing to keep health care affordable and more on surprise medical bills.
The federal government, hospitals and physicians have been gravitating toward bundled payments, but new studies challenge the belief that they help achieve cost savings. Meanwhile, CMS is proposing changes to Medicare Advantage payments for 2021, including an increase in the percentage of patient “encounter data” used to calculate payments.