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Health Estimates Newswire

Sep. 6: Urgent Care Clinic Visits Increasing Among Commercially Insured Americans, Study Finds

Urgent Care Clinic Visits Increasing Among Commercially Insured Americans, Study Finds.

TIME  (9/5, Ducharme) reports, “Urgent care centers are increasingly becoming Americans’ go-to option for certain health problems,” researchers concluded after looking at eight years’ worth of data on “Americans younger than 65 who were covered by Aetna.” The study revealed that urgent care clinic visits “increased by 119% among commercially insured Americans between 2008 and 2015,” while emergency department “visits for low-severity conditions – like those treated at urgent care centers – decreased by 36%.” The findings  were published online in JAMA Internal Medicine.

Legislation and Policy

Federal Judge To Rule On Request To Suspend ACA While Lawsuit Unfolds.

The Washington Post  (9/5, Goldstein) reports that oral arguments in the latest suit challenging the ACA began in a Texas courtroom on Wednesday. The plaintiffs, 20 GOP-led states, “sought to persuade a federal judge to halt the sprawling health-care law.” They contend that the ACA is unconstitutional because the tax reform bill eliminated the penalty associated with its individual mandate. The states asked US District Judge Reed O’Connor “to grant a preliminary injunction that would suspend the law while the rest of the case unfolds – a possibility that could throw significant aspects of the U.S. health-care system into chaos.” The article says O’Connor “did not immediately rule on the request or indicate when he would do so.”

        The New York Times  (9/5, A1, Goodnough) reports that “the case has become not simply a threat to the landmark legislation.” Democrats have attempted “to make it both a flash point in the battle over whether to confirm Judge Kavanaugh and a crucial prong in their strategy to retake control of the House and Senate in the midterm elections.” The Times says “it has already made some Republicans jumpy, especially those in tight re-election contests, because the Trump administration explicitly said in a legal filing in June that it agreed with the argument of Texas and 19 other Republican-controlled states.”

Senate Unanimously Passes Bill To Ban Medicare Insurers From Using Pharmacy “Gag Clauses.”

The Washington Examiner  (9/5, Leonard) reports that on Wednesday, the Senate unanimously approved a bill which “would ban Medicare insurers from enforcing ‘gag clauses’ that forbid pharmacies from telling customers about cheaper ways to buy drugs.” The article says, “The Know the Lowest Price Act is intended to help patients covered under Medicare to find out if their prescription would cost less if they were to pay for it out of pocket rather than through their insurance plan.” The piece adds that the changes “explicitly apply to Medicare Part D, which pays for prescription drugs, and to Medicare Advantage.”

Public Health and Private Healthcare Systems

DOJ Reportedly Preparing To Approve Healthcare Mergers.

The Wall Street Journal  (9/5, A1, Kendall, Mathews, Terlep, Subscription Publication) reports people familiar with the matter say the Justice Department is preparing to approve CVS’ planned purchase of health insurer Aetna and Cigna’s planned acquisition of Express Scripts. People familiar with the discussions say that CVS and Aetna may be required to sell off assets related to Medicare drug coverage to resolve competition concerns, while the Cigna-Express Scripts deal may not have any such conditions. The Journal says the deals indicate the changing nature of the healthcare industry as large players seek to have multiple lines of business.

Hospital Groups Sue HHS Again Over Cuts To 340B Program.

The Washington Examiner  (9/5, Leonard) reports that several “hospital groups has re-filed a lawsuit against the Trump administration over its cuts to a drug discount program” called 340B. The article says the suit “was filed in the U.S. District Court of the District of Columbia by the American Hospital Association, the Association of American Medical Colleges, and America’s Essential Hospitals, as well as three hospitals.” The plaintiffs contend “the cuts violate the law, saying they are outside of the authority of the Department of Health and Human Services, which authorized the cuts.”

        Modern Healthcare  (9/5, Luthi, Subscription Publication) reports the plaintiffs “have estimated that the reimbursement cuts of 22.5% off the drug list price amount to $1.6 billion each year.” They say “the CMS rule was an overreach of the HHS secretary’s administrative authority.”

New Mexico Health Exchange Rates Stabilize.

The AP  (9/5) reports that “average rates for purchasing health insurance in 2019 are stabilizing on New Mexico’s subsidized health care exchange,” decreasing by an average of about 1 percent among four health insurers on the state exchange. The AP says premiums for mid-level coverage in 2018 had risen more than 35 percent “amid Republican attempts to overturn the Affordable Care Act.”

Amerigroup Renews Effort To Convince Judge To Force Rebidding Of Kansas’ Medicaid Contract.

The Topeka (KS) Capital-Journal  (9/5) reports, “Amerigroup insurance company renewed a court fight Wednesday to convince a judge to force rebidding of Kansas’ Medicaid contract and disclosed a secret meeting with officials in Gov. Jeff Colyer’s administration to search for a settlement to litigation.” For is part, Kansas Department of Health and Environment secretary Jeff Andersen “said the [original] selection from among six finalists reflected feedback from KanCare consumers, advocacy groups and legislators,” adding that the department’s goal was to create a “cost effect[ive] and dependable Medicaid program.”

Connecticut Residents Plead With Insurance Regulators Not To Approve Rate Hikes For ACA Plans.

The Hartford (CT) Courant  (9/5, Singer) reports that residents “pleaded with Connecticut regulators Wednesday to hold the line on increasingly pricey health insurance as two insurers pointed to political turmoil in Washington as a big driver in their request for higher rates.” The “hearing focused on rate proposals filed by Anthem Health Plans and ConnectiCare Benefits Inc. for individual plans marketed through Access Health CT, the state-sponsored health insurance exchange.” Anthem has requested an average increase of 9.1 percent, while CBI has asked for an average rate hike of 13 percent. These two insurers cover more than 100,000 Connecticut residents.

Also in the News

PhRMA Report Blames Hospitals For Marking Up Prescription Prices.

Fierce Healthcare  (9/5, Reed) says the industry group Pharmaceutical Research and Manufacturers of America (PhRMA) released a report Wednesday that casts blame on hospitals for their role in marking up prescription drug costs. Their report found that “hospitals mark up the cost of prescription drugs on average of nearly 500%,” while “17% of hospitals mark up the price of prescription drugs by at least 700%.” The article adds, “PhRMA said average markups were likely much higher at hospitals participating in the 340B drug pricing program where medicines are acquired, on average, at a 50% discount.”

        Healthcare Finance News  (9/4, Lagasse) reports that the analysis was prepared by The Moran Company on behalf of PhRMA. The report used Centers for Medicare and Medicaid Services data for total costs and charges for medicines at 3,792 hospitals. This study comes after America’s Health Insurance Plans previously “said that big pharma was largely responsible for rising drug prices.”

About One-Third Of New Yorkers Have Healthcare Coverage Through Government-Funded Plans, Report Says.

The Albany (NY) Times Union  (9/5, Bump) reports around one third of New Yorkers, over seven million, “receive health coverage through a publicly funded health plan, an increase of 57 percent from one decade ago, according to a report issued Wednesday by the state Comptroller’s Office.” Comptroller Thomas DiNapoli said that the state’s dependence on publicly funded health plans makes its particularly vulnerable to potential changes in federal policy.

        The Rochester (NY) Democrat & Chronicle  (9/5, Spector) reports that DiNapoli said in a statement, “There are disturbing calls in Washington to repeal the Affordable Care Act (ACA) and make radical changes to Medicaid. We cannot go backwards on health care and force people to choose between buying groceries or seeing a doctor.” The New York Post  (9/5, Campanile) also covers the story.

Jeff Sopko