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Health Estimates Newswire

Aug. 9, 2018: Trump Administration Seeks Public Comment On Future Risk Corridor Payments

Trump Administration Seeks Public Comment On Future Risk Corridor Payments.

The Washington Examiner  (8/8, Leonard) reports that the Trump Administration is seeking public “input on an Obamacare program that collects and pays out billions of dollars to health insurance companies.” The Administration has said it intends to make the payments “for 2017, after initially saying it was putting payments on hold.” CMS is requesting “comment about how to move forward in 2018 for the payments that will go out in 2019.” The article adds that when the Administration decided to proceed with risk corridor payments for last year, CMS Administrator Seema Verma stated, “Today’s proposed rule continues our effort to help stabilize the individual and small group markets. ... Our goal has been, and will continue to be, to stabilize the market and provide American consumers with more affordable health coverage options.”

Legislation and Policy

ACA Subsidies Surpass Medicaid Spending, Prompting Concerns About Sustainability.

Modern Healthcare  (8/8, Luthi, Subscription Publication) reports that the federal government’s spending on ACA “premiums has raced past its per-person spending on Medicaid expansion, and the gap is poised to increase – a trend that has some policy experts shaking their heads over the long-term economic picture and at least one major insurer questioning the sustainability of the individual market.” According to the Congressional Budget Office, federal spending on ACA premiums for this year “more than doubled from 2014.” The CBO estimates that amount “will nearly double again over the next decade.” Data indicate the government is paying “an average of $6,300 annually for every subsidized enrollee in fiscal 2018.” That figure is expected to reach about $12,500 in 2028. By comparison, “Medicaid spends $4,230 per non-disabled adult, set to inflate at 5.2% annually to just over $7,000 per person in 2028.”

Federal Judge In Texas Could Rule In ACA Lawsuit Soon.

The Texas Tribune  (8/8, Platoff) reports on the lawsuit filed by Texas challenging the Affordable Care Act which has been joined by 19 other states. A federal judge in North Texas “could decide any day whether to let the law stand, block it in part or entirely, or to ask for more arguments from both sides” and “experts predict a decision in the next few months.” The article adds, “Texas still has the nation’s highest uninsured rate, but that rate declined significantly after major Obamacare provisions went into effect.”

Fear Of Jeopardizing Citizenship Applications Could Prevent Legal Immigrants From Using Healthcare Services.

Colby Itkowitz writes in the Washington Post  (8/8) “The Health 202” blog that the White House is “seriously” mulling “a new policy that would penalize legal immigrants seeking permanent status for accepting health-care services paid for by the government.” The proposed “rule, which is expected to be officially announced soon per NBC News, would change the definition of when a legal immigrant is considered a ‘public charge’ to the government, and impact the decision over whether they qualify for permanent resident status.” Itkowitz says that according to one advocate for immigrants, the mere notion of this change “has already had a ‘real chilling effect’ on immigrants using health-care services.” Advocates warn this could prevent legal immigrants from using services such as the ACA, Medicaid, and CHIP out of fear.

North Dakota Dems Urge State To Abandon ACA Lawsuit.

The AP  (8/8) reports that Democratic legislators in North Dakota “want the state to withdraw from a lawsuit that seeks to invalidate” the ACA. They contend that “if the lawsuit is successful, it would strip protections for thousands of North Dakotans with pre-existing conditions. They say it also would end the ability to allow children to stay on their parents’ health plan until the age of 26.”

Public Health and Private Healthcare Systems

Amazon’s Healthcare Ambitions Have Pushed The Industry Into Deals.

The New York Times  (8/8, De La Merced) “DealBook” says, “Just the threat of competition from Amazon has driven companies across many industries into deals.” This has been particularly evident in healthcare. Indeed, the “possibility of Jeff Bezos’s e-commerce juggernaut starting a pharmacy business was partially responsible for two of the largest health care mergers of the past 12 months: pharmacy chain CVS Health’s announced $69 billion merger with the health insurer Aetna and health insurer Cigna’s announced $52 billion deal for Express Scripts, a pharmacy benefit manager.” Now, activist investor Carl Icahn “is citing Amazon in opposing the latter deal.” He “argued that Amazon’s acquisition of online pharmacy PillPack puts the e-commerce giant in competition with Express Scripts’s own mail-order pharmacy business.” The Times says, “Until now, Amazon’s much-discussed entrance into health care was a reason to strike deals. Its potential entrance, along with concerns about rising drug prices, had led health care companies to rethink how they can compete. It was those dynamics that helped push Cigna into its deal for Express Scripts.” The New York (NY) Business Journal  (8/8) also reports on the story.

AMA, Other Groups Urge CMS To Improve MIPS.

RevCycle Intelligence  (8/8, LaPointe) reports that although “providers commend CMS for replacing the Sustainable Growth Rate with MACRA and its Quality Payment Program, many still have some reservations about the Medicare program.” The article adds, “After completing the first Quality Payment Program performance year in 2017, providers are expressing concerns to policymakers and healthcare leaders regarding the program and its two payment tracks: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).” During a recent House Subcommittee on Health hearing, representatives from top healthcare and industry groups outlined their challenges and offered recommendations. For instance, the American Medical Association urged “CMS to modify the reporting requirements of the MIPS performance category.” AMA immediate past president David O. Barbe, MD, MHA, said, “CMS should also change Promoting Interoperability reporting requirements to attestation alone and develop new measures that utilize not only certified electronic health records (EHRs), but also technology that builds on certified EHRs.”

States Questioning Costs Of Using PBMs For Medicaid.

On its “Morning Edition” program and in its “Shots” blog, NPR  (8/8, Kodjak) “Shots” reports, “Several states are questioning the cost of using pharmacy middlemen to manage their prescription drug programs in a movement that could shake up the complex system that manages how pharmaceuticals are priced and paid for.” For example, Ohio is in court seeking “to release a report detailing what it paid two middlemen, CVS Health and Optum, to manage its Medicaid program’s prescription drug plans.”

UnitedHealth Has “Tentative Agreement” To Buy Genoa.

Axios  (8/8, Primack) reports that UnitedHealth has “at least a tentative agreement” to buy specialty pharmacy operator Genoa Health from private equity firm Advent International, according to an unnamed source who is familiar with the deal. The article says, “UnitedHealth is basically seeking to control a specialty channel by buying Genoa, whose 400 full-service pharmacies are located within community mental health centers.”

        Also reporting are Reuters  (8/8, Lahiri) and the Washington Examiner  (8/8, King).

Cigna Defeats Texas Hospital Lawsuit Over Underpaid Claims.

Bloomberg BNA  (8/8, Castro-Pagan) reports that Cigna Healthcare defeated a lawsuit which accused it of underpaying hundreds of medical benefit claims. The suit was filed by North Cypress Medical Center of Houston. A federal judge in Texas ruled that Cigna “didn’t abuse its discretion when it reduced benefit payments to North Cypress Medical Center Operating Co. Ltd after it learned that the hospital engaged in fee-forgiving – a practice where out-of-network providers charge patients less than what they owe under their health insurance plans,” according to the article. The ruling “is a significant victory for Cigna in a long-running lawsuit by North Cypress, which sought to hold the insurer liable for at least $50 million in unpaid claims,” Bloomberg BNA adds.

Jeff Sopko