Health Estimates
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Health Estimates Newswire

Aug. 30, 2018: Trump Administration Seeks To Give Medicare Drug Plans More Options In Effort To Lower Prices

Trump Administration Seeks To Give Medicare Drug Plans More Options In Effort To Lower Prices.

The Washington Examiner  (8/29, King) reports that on Wednesday, the Trump Administration took action “to give Medicare drug plans more choices in the products they can offer patients, in a bid to boost their buying power and lower drug prices.” CMS said beginning “in 2020, Medicare prescription drug plans can take advantage of a tool, called an indication-based formulary, that expands the choices of products they can cover, allowing plans to opt for cheaper drugs in certain cases.” This change was the latest move in the Administration’s effort to lower prescription drug prices. Commenting on it, HHS Secretary Alex Azar said, “This is a significant step in modernizing the successful Medicare Part D program by giving plans the tools that serve patients well in the private sector.”

        Congressional Quarterly  (8/29, Clason, Subscription Publication) reports that CMS “will allow plans to determine which medical conditions a drug can be used for beginning in 2020.” At present, plans must “cover a chosen drug for every condition it is approved to treat.” CMS Administrator Seema Verma is quoted as saying, “By allowing Medicare’s prescription drug plans to cover the best drug for each patient condition, plans will have more negotiating power with drug companies, which will result in lower prices for Medicare beneficiaries.”

        Modern Healthcare  (8/29, Kacik, Subscription Publication) and Fierce Healthcare  (8/29, Sweeney) also cover the story.

Legislation and Policy


Bill Seeks To Overturn Trump Rule That Expands Access To Non-ACA-Compliant Plans.

The Hill  (8/29, Sullivan) reports that on Wednesday, Sen. Tammy Baldwin (D-WI) “introduced a measure to overturn a Trump administration rule expanding access to non-ObamaCare insurance plans.” This “move is a step in Senate Democrats’ plan to force a vote on the measure as they seek to argue Republicans are attacking protections for people with pre-existing conditions, a key argument Democrats want to make in the midterm election campaign.” The article says Baldwin has indicated “she has the support of the 30 senators necessary to force a vote on the measure under the Congressional Review Act.” Still, “even a failed vote would allow Democrats to highlight the issue before the election.”

        The Huffington Post  (8/29, Cohn) reports that it seems unlikely the Senate will pass the measure. Nevertheless, “Baldwin’s gambit could force her GOP colleagues to declare publicly whether they support this latest effort to undermine the Affordable Care Act’s insurance reforms – and to do so shortly the midterm elections, amid polling that shows voters care a lot about those reforms.”

        The Milwaukee Journal Sentinel  (8/29, Glauber) quotes Baldwin as saying, “The Trump Administration is rewriting the rules on guaranteed health care protections that millions of Americans depend on. ... They are moving forward on an expansion of junk insurance plans that can deny coverage to people with pre-existing conditions and don’t have to cover essential services like prescription drugs, emergency room visits and maternity care.”

        Vox  (8/29, Scott) and Modern Healthcare  (8/29, Luthi, Subscription Publication) also cover the story.


Insurers Push For FCC To Approve Petition Clarifying HIPAA-Covered Entities’ Ability To Text, Call Patients.

FierceHealthIT  (8/29, Sweeney) reports that a group of insurers led by the American Association of Healthcare Administrative Management is “reviving a push for the Federal Communications Commission (FCC) to grant a 2016 petition that would clarify now HIPAA-covered entities can use text messages or calls to communicate with patients.” The group “says two simple clarifications to the Telephone Consumer Protection Act (TCPA) would resolve ongoing confusion over a 2015 order that discourages organizations across the healthcare industry from providing patients with reminders about their health benefits or recommended screenings,” according to the article.


Insurers Pushing For Repeal Of ACA’s Health Insurance Tax.

Fierce Healthcare  (8/29, Sweeney) reports that the health insurance industry “and a coalition of business associations are ramping up efforts to repeal the health insurance tax, a provision of the Affordable Care Act that will cost insurers $14.3 billion in 2018.” While “the on-again, off-again fee has been suspended for 2019, insurers are pushing for a delay in 2020 as well.” New data indicate insurers’ liability for the tax will reach $16 billion in 2020, but that figure could reach $20.3 billion, according to one expert.

Public Health and Private Healthcare Systems


VA Secretary Says He Won’t Privatize His Agency’s Healthcare Services.

The AP  (8/29, Karnowski) reports that Secretary of Veterans Affairs Robert Wilkie “pledged to the American Legion on Wednesday that he won’t privatize his agency’s health care services even as it increases options for veterans to seek care in the private sector.” Wilkie “also pledged better customer service as a result of the VA overhaul bill that President Donald Trump signed recently in response to the long waits for appointments and short-staffing that have plagued VA hospitals across the country,” according to the AP.


CBO Declines To Estimate Cost Of Sanders’ Medicare For All Proposal.

The Hill  (8/29, Sullivan) reports, “A recent study concluding that Sen. Bernie Sanders’ (I-Vt.) ‘Medicare for all’ bill would cost $32 trillion has set off a furious debate over the cost of the plan.” The article says “there’s one estimate that would make an even bigger splash: the score from the nonpartisan Congressional Budget Office (CBO).” But “it does not appear that CBO is working on a spending estimate, despite a request from Sen. John Barrasso (R-Wyo.), who asked for a cost analysis in September in order to highlight the steep costs for Medicare for all, also known as single-payer.”


Texas Managed Care Organizations Are Paying Late, Denying Patients Access, Providers Say.

The Austin (TX) American Statesman  (8/29, Chang, Subscription Publication) reports the Texas House Committee on Human Services met yesterday “to hear complaints about Medicaid managed care” organizations, which providers claim are paying them late, overloading them with paperwork, and denying patients access to essential care. As such, “providers asked force the more than dozen managed care organizations across the state to adopt similar processes and standards,” since “providers said the companies differ in what they consider a medically necessary service and will ask for different types of documents before approving a service.” For their part, “members of a few managed care companies told lawmakers they would be willing to work together to standardize processes to eliminate paperwork for providers and offered to address providers’ specific complaints at the hearing.”


California Poised To Become First State To Ban Implementation Of Medicaid Work Requirements.

Modern Healthcare  (8/29, Dickson, Subscription Publication) reports that California intends “to be the first state to prohibit its health department from ever seeking a waiver that imposes work requirements on Medicaid enrollees.” Earlier this week, the “state Senate passed SB 1108, authored by Democrat state Sen. Ed Hernandez, on a 29-10 vote on Tuesday; the bill has already passed the State Assembly. Now, it will go to Democratic Gov. Jerry Brown for his signature.” Hernandez is quoted as saying, “If this bill is approved by the governor, California would be the first state in the nation to stand against Trump’s effort to take Medi-Cal coverage away from those who need it most. ... We need to make sure the millions of Californians can keep their comprehensive health coverage.”


Wisconsin Group Insurance Board Reinstates Coverage Of Transgender Treatment For State Workers.

Kaiser Health News  (8/29, Huetteman) reports that “in a surprising reversal,” Wisconsin’s Group Insurance Board voted to “again offer insurance coverage to transgender state employees seeking hormone therapy and gender confirmation surgery.” Members of the Group Insurance Board, which manages the insurance program for Wisconsin’s public workers and retirees, last week voted 5-4 to overturn its current policy barring treatments and procedures “related to gender reassignment or sexual transformation,” according to the article. The change will take effect January 1, allowing insurance to defray the cost of care deemed medically necessary, the piece adds.

Also in the News


Even A Small Amount Of Medical Debt Can Prompt Calls From Collection Agencies, Study Suggests.

The AP  (8/29, Murphy) says a study  published in Health Affairs which examined the credit reports of “more than 4 million people” found that “2 percent of adults had medical bills under $200 sent to a collections agency” in 2016. “Over half of the annual medical collections were for less than $600,” the AP adds. The study also found that “the percentage of people in trouble with medical debt and the size of what is owed generally peaked at a young age, even though medical spending typically rises as people grow older,” according to the AP.


Missouri Medicaid Managed-Care Company May Have Compromised Personal Data Of 19,570 Children Because Of Mailing Error.

The Kansas City (MO) Star  (8/29, Marso) reports WellCare Health Plans Inc., which “administers Missouri Medicaid plans, says it accidentally exposed the personal health information of 19,570 children.” The article says, “A vice president for WellCare Health Plans Inc. said in a letter to The Star that the company learned on July 25 that a ‘mailing error’ caused reminders about well-child visits for the company’s Missouri Care members to be sent to the wrong addresses.” The missive also stated, “The letters contained personally identifiable health information including (the) child’s name, age and provider name.”

Jeff Sopko