Customers File Suit Against Centene, Alleging Insurer Fails To Provide Adequate Access To Physicians.
The New York Times (1/11, Abelson, Subscription Publication) reports that on Thursday, Centene customers “filed a federal lawsuit…claiming the company does not provide adequate access to doctors in 15 states.” The suit alleges that customers “‘have difficulty finding – and in many cases cannot find – medical providers,’ who will accept patients covered under policies sold by Centene.” Furthermore, it accuses Centene of misrepresenting “the number, location and existence of purported providers by listing physicians, medical groups and other providers – some of whom have specifically asked to be removed – as participants in their networks and by listing nurses and other non-physicians as primary care providers.” A spokeswoman for Centene disputed the allegations, saying, “We believe our networks are adequate and we work in partnership with our states to ensure our networks are adequate and our members have access to high-quality health care.”
The Hill (1/11, Weixel) reports that the suit claims customers who purchased Centene’s ACA plans “had trouble finding in-network doctors or hospitals, and often found that doctors who were advertised as in-network actually were not.” Indeed, it alleges “customers found the provider network Centene said was available was ‘largely fictitious.’” The suit also says the company “targets low-income customers who qualify for substantial government subsidies ‘while simultaneously providing coverage well below what is required by law and by its policies.’”
Bloomberg News (1/11, Tracer) reports that the suit, which was filed on behalf of two customers, is seeking “class-action status to represent all customers of Centene’s Obamacare plans, which are sold under the Ambetter brand.”
Legislation and Policy
Rep. Brady Says Repeal Of ACA’s Cadillac Tax Could Be Included In Spending Bill.
Reuters (1/11, Cornwell) reports that on Thursday, House Ways and Means Committee Chairman Kevin Brady (R-TX) said eliminating “the so-called ‘Cadillac’ tax on high-cost employer-provided health insurance could be part of the spending deal now under negotiation in Congress.” He stated, “We want to get rid of it,” and added that “this could ‘possibly’ be part of an agreement lawmakers are seeking to avoid a government shutdown on Jan. 19.”
The Washington Examiner (1/11, King) quotes Brady as saying, “Right now…even Democrats who put that awful tax place, believe it needs to be delayed.”
House Republicans Seek To “Overhaul” 340B Drug Discount Program This Spring.
STAT (1/11, Mershon) reports that House Republicans on the Energy and Commerce Committee are “gearing up to overhaul” the Medicare 340B drug discount program this spring, according to committee Chairman Greg Walden (R-OR). The committee “will also examine whether to restore a recent $1.6 billion cut to the program, which came under a Trump administration rule that took effect Jan. 1.”
Public Health and Private Healthcare Systems
Renewing CHIP For 10 Years Saves The Government Money, CBO Says.
The Washington Post (1/11, Cunningham) reports in “Health 202” that “now there is really, truly no excuse for Congress to let health insurance for 9 million low-income kids collapse” following the Congressional Budget Office’s analysis this week that “reauthorizing CHIP saves money instead of costing money.” The Post says, “Lawmakers no longer have to pay for reauthorizing CHIP, as long as they expand the time frame in which they extend it from five years to seven or more.”
Vox (1/11, Kliff) reports the CBO’s new estimate that extending CHIP for 10 years would save the federal government $6 billion was issued in a letter to Rep. Frank Pallone (D-NJ). The CBO wrote, “Extending funding for CHIP for 10 years yields net savings to the federal government because the federal costs of the alternatives to providing coverage through CHIP (primarily Medicaid, subsidized coverage in the marketplaces, and employment-based insurance) are larger than the costs of providing coverage through CHIP during that period.”
The Washington Examiner (1/11, King) reports that the new projections released Thursday found that “a 10-year extension would increase the deficit from 2018 to 2020 but reduce it each year after that through 2027.”
Meanwhile, Newsweek (1/11, Sanders) reports that some states “will run out of money by February 1 if an agreement is not made, according to estimates from Georgetown University’s Health Policy Institute based in Washington, D.C., but more conservative estimates from the U.S. Centers for Medicare and Medicaid Services (CMS) suggest several states risk burning through the federal funds by January 19.” Newsweek identifies 24 states and DC that “are considered the most vulnerable for running out of money by the end of January due to their spending rate[s].”
Trump Administration To Allow States To Impose Work Requirements On Some Medicaid Recipients.
In a front-page article, the New York Times (1/11, A1, Pear, Subscription Publication) reports that on Thursday, the Trump Administration said “it would allow states to impose work requirements in Medicaid, a major policy shift in the health program for low-income people.” The change would apply to certain able-bodied adults. CMS Administrator Seema Verma is quoted as saying, “Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction.”
The Washington Post (1/11, Blake) reports that this is “a legally controversial decision because it would impose such requirements for the first time in Medicaid’s half-century history.” It remains to be seen if “the law allows for it. And opponents quickly cried foul, arguing that the move would harm the poor.”
The Wall Street Journal (1/11, Radnofsky, Armour, Subscription Publication) reports that this move would alter Medicaid in certain states from a program which provides guaranteed benefits depending on consumers’ income, to one which can refuse assistance to some adults if they fail to meet certain conditions. The article also quotes Verma as saying, “This is in response to proposals we are receiving from states. … This effort is about helping people rise out of poverty.”
The Los Angeles Times (1/11, Levey) reports that this “plan sets the stage for a potentially long and contentious legal battle over the shape and purpose of a health program that more than 70 million Americans now depend on.” Indeed, the National Health Law Center, a patient advocacy organization, “is preparing to challenge the work requirements in court.” About 10 states are waiting for CMS to approve waivers which allow them to impose work requirements on Medicaid recipients. Among them are Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin.
Medicare Panel Recommends Changes To Biosimilars, Post-Acute Care, Pay For Physicians.
Congressional Quarterly (1/11, Clason, Subscription Publication) reports that MedPAC “approved draft recommendations it says would help curb costs for biosimilar drugs and post-acute care.” The group unanimously approved a proposal that would require manufacturers of biosimilar drugs “to provide discounts to beneficiaries that get stuck in the so-called Medicare coverage gap, also known as the ‘doughnut hole.’” MedPAC also unanimously “approved a stopgap proposal to equalize payment rates across various post-acute care settings until Congress adopts MedPAC’s broader plan for a single unified payment system.” The article also discusses MedPAC’s decision to eliminate the MIPS due to its burdensome reporting requirements.
Arizona Legislator To Propose Medicaid Buy-In Option.
The Arizona Republic (1/11, Alltucker) reports that Arizona state Rep. Kelli Butler (D) of Phoenix plans to introduce a law this legislative session that would permit uninsured Arizonans to purchase Medicaid coverage. Butler “said the Medicaid buy-in option would provide a practical insurance option for residents who don’t qualify for subsidized plans through the Affordable Care Act marketplace.” Other states, including Nevada and Minnesota, have considered similar plans, but they have faced “an uphill battle.” Butler said, “I can’t imagine why everyone wouldn’t support this. It is solving a problem in a real way.”