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Aug. 16, 2018: Azar Touts Short-Term Plans, Calls ACA "Broken."

Azar Touts Short-Term Plans, Calls ACA “Broken.”

HHS Secretary Alex Azar writes in the Washington Post Share to FacebookShare to Twitter (8/15) that the ACA “effectively split the [US] individual insurance market in two,” with about eight million enrollees “receiving ever-growing taxpayer subsidies,” and a larger number facing “the full premium increases driven by the law’s broken regulations” or going uninsured. Azar says this is why the Trump Administration recently expanded the availability of “short-term, limited-duration insurance for up to a year, assuming their state allows it. ... These short-term plans can be a good option for many Americans priced out of Obamacare’s regulations.” He concludes that starting in October, “thanks to this president, insurers and states will have more freedom to offer consumers more options. Obamacare remains broken at its core, but this administration isn’t shutting out the law’s forgotten Americans. Instead, we’re finally giving them affordable choices.” 
Legislation and Policy

Sen. Grassley Urges Justice Department To Scrutinize Healthcare Mergers.

Fierce Healthcare Share to FacebookShare to Twitter (8/15, Meltzer) reports Sen. Chuck Grassley (R-IA) has asked the Department of Justice’s antitrust lawyers to “conduct a careful analysis” of the proposed CVS-Aetna and Cigna-Express Scripts mergers on the pharmaceutical supply chain. Grassley’s letter fears that such vertical integration might keep competitors from entering the market, and “we must ensure that these transactions do not foreclose competition and consumer access, or hinder innovation, especially in underserved rural areas,” he wrote. 
US Rep. Rogers Says GOP Could Repeal ACA Next Year If They Retain House Majority.

The Anniston (AL) Star Share to FacebookShare to Twitter (8/15) reports US Rep. Mike Rogers (R-AL) told an audience in Anniston that the GOP could repeal and replace the Affordable Care Act if the GOP retains its majority in the US House of Representatives. He said at a meeting of the Anniston Rotary Club, “Assuming this fall turns out as some of us hope it does, and we pick up a majority in the House, we’re also going to pick up two or three seats in the Senate.” Rogers’ general election opponent, Mallory Hagan, “said Wednesday that Rogers had more than a decade in office to come up with a better healthcare plan.” 
States Creating Reinsurance Programs To Help Lower Premiums For ACA Plans.

Kaiser Health News Share to FacebookShare to Twitter (8/15, Findlay) reports that high premiums for ACA plans have been a concern for Minnesotans who purchase coverage on the individual market; however, the state’s “effort to help insurers cover some patients’ high bills is curbing premiums.” The article says, “Amid a public outcry, the legislature last year took several steps to stabilize its individual insurance marketplace.” For instance, legislators “launched a ‘reinsurance’ program” which “helps pay the costs insurers incur for people with high medical bills.” For their part, insurers – “knowing that these ‘outlier’ expenses will be covered – can lower premiums.” The piece adds that Alaska took similar action in 2016, and says these two states have become examples “for other states eager to prevent startling premium increases in the individual insurance marketplace.” 
Public Health and Private Healthcare Systems

United Healthcare Decides To Not Reimburse Patients For Amniotic-Tissue Product From MiMedx.

The Wall Street Journal Share to FacebookShare to Twitter (8/15, Morgenson, Subscription Publication) reports that United Healthcare has determined amniotic tissue products made by MiMedx Group Inc. and other manufacturers are “unproven and/or not medically necessary for any indication,” and will not reimburse patients for their use, according to the insurer’s most recent medical policy update bulletin. The new policy came about because of “insufficient clinical evidence of safety and/or efficacy in published peer-reviewed medical literature” about the products, the bulletin said. 
Nevada Health Link Signs Contract With GetInsured.

The Las Vegas Review-Journal Share to FacebookShare to Twitter (8/15) reports Nevada Health Link, the state’s health insurance exchange, “announced Tuesday it will contract with GetInsured to operate a state-based exchange come 2019.” The company, which operates in seven other states, “will run Nevada’s eligibility and enrollment platforms online, along with operating the exchange’s call center, according to a Tuesday press release from the Silver State Health Insurance Exchange.” State Exchange Executive Director Heather Korbulic said in the release that the transition will save the state more than $18 million, “offer a better consumer experience, and provide the Marketplace with timely and efficient access to data that will ultimately improve marketing efforts.” 
Ohio’s Medicaid Program Wants Managed-Care Companies To End Contracts With PBMs.

Modern Healthcare Share to FacebookShare to Twitter (8/15, Livingston, Subscription Publication) reports, “Ohio’s Medicaid department is directing its managed-care organizations to quit their contracts with pharmacy benefit managers because of opaque pricing practices officials said cost the state millions of dollars.” As a result, the five managed-care companies offering Medicaid coverage to Ohioans “must strike up new contracts with companies able to manage pharmacy services using a more transparent pricing model by Jan. 1, 2019.” The article says this move follows the release of “an analysis commissioned by the Medicaid department” which “found that the two largest PBMs operating in the state – CVS Caremark and OptumRx – billed managed-care plans $223.7 million more for prescription drugs than they paid pharmacy providers in one year under a practice known as ‘spread pricing.’” 
Thousands Of Arkansas Medicaid Recipients At Risk Of Losing Coverage Due To Work Requirements.

The Hill Share to FacebookShare to Twitter (8/15, Hellmann) reports, “New data released by the state of Arkansas on Wednesday show Medicaid enrollees are struggling to comply with the state’s new work requirements, putting thousands at risk of losing health care.” The requirements took effect in June. Under the new rules, recipients who fail to provide evidence of “their work activities to the state,” or who “aren’t meeting the 80-hour-per-month work requirement, could lose coverage if they don’t meet the requirements for three months out of the year.” Data indicate “5,426 people are in their second month of noncompliance.” In addition, last month, “the second month in which the work requirements were in effect – 12,722 people either failed to report their activities to the state or didn’t meet the 80-hour-a-month requirement.” 

        Congressional Quarterly Share to FacebookShare to Twitter (8/15, Williams, Subscription Publication) reports that the data also show only about “850 people met July’s work reporting requirement.” The article says “more than 30,000 were exempt because they are medically frail, pregnant, in substance abuse treatment or another reason.” The piece adds that the latest figures were released “a day after consumer advocacy groups filed a federal lawsuit on behalf of three low-income Arkansas residents, aiming to block the state’s work requirements.” 
Blue Cross Blue Shield Of Arizona Investing $10 Million In Opioid Abuse Initiative.

The Arizona Republic Share to FacebookShare to Twitter (8/15, Innes) reports Blue Cross Blue Shield of Arizona announced Tuesday that will invest $10 million over the next three years in an initiative called Mobilize AZ to help reduce opioid abuse in the state. The initiative “will include a minimum of $3 million in annual grants to Arizona organizations and academic institutions, plus funding that will fill in gaps in preventing and treating the misuse of opioids and other substances, said Pam Kehaly, Blue Cross Blue Shield of Arizona president and CEO.” 
Oregon Officials Mulling Plan That Would End Medicaid Coverage Of Opioids For Patients With Chronic Pain.

STAT Share to FacebookShare to Twitter (8/15, Facher) reports that Oregon officials are mulling “a first-in-the-nation proposal that would end coverage of opioids for many chronic pain patients who...are enrolled in Oregon’s Medicaid program. Over just 12 months, beginning in 2020, they would see their opioid doses tapered to zero.” The article says officials “declined to provide an estimate of how many pain patients the policy could affect,” although “nearly 1 million Oregonians are enrolled in Medicaid,” and data indicate some “10 percent of adults nationwide have experienced pain every day for the previous three months.” The piece adds, “An army of those patients here is convinced that plan will do them vastly more harm than good.” 
Wisconsin DHS Awards $400 Million Contract To Oversee Medicaid’s Management Information System To DXC.

The Milwaukee Business Journal Share to FacebookShare to Twitter (8/15, Kirchen, Subscription Publication) reports, “The Wisconsin Department of Health Services sought a vendor to take over and enhance the agency’s Medicaid management information system and ultimately awarded the contract to the incumbent firm for $400 million over five years.” The article says that in January 2017, DHS issued a request for proposals. Last August, the department “said it intended to award the contract to DXC Technology of Tysons, Va., pending negotiations.” On Tuesday, DXC announced it had been awarded the five-year contract which can be renewed for five additional one-year terms. 
Op-Ed: Medicare Should Not Reduce Compensation For Physicians Who Treat Patients With Severe Conditions.

Timothy Sullivan, MD, an assistant professor of medicine in the Division of Infectious Diseases at Icahn School of Medicine at Mount Sinai in New York, writes in STAT Share to FacebookShare to Twitter (8/15) that some physicians “don’t like to admit it, but money can have a major influence on physicians’ behaviors.” He says, “For years, Medicare seemed to recognize this by paying doctors more for complicated patient visits and less for straightforward ones.” But the federal government intends “to drastically alter Medicare payments to physicians by instituting a flat rate per visit, regardless of how sick a patient is. This change, which is slated to start in 2019, could have unintended – and harmful – consequences for patients with severe illnesses.” 

Jeff Sopko