Policy Corner, week of October 7, 2019 – Protecting Medicare from Socialist Destruction
Trump has a vision for Medicare
This week at a rally in Florida, Trump gave insight into the healthcare executive order he had signed earlier that day. Originally titled “Protecting Medicare from Socialist Destruction,” the order, now called the more-official-sounding “Protecting and Improving Medicare for our Nation’s Seniors,” is somewhat lacking in policy, but does give a positive nudge toward Medicare Advantage as the future of Medicare.
The rest of the order includes generic language surrounding lowering healthcare costs, eliminating inefficiencies, promoting innovation, and more.
DSH cuts get pushed back by Senate
The ever-looming DSH cuts were pushed back once again by the Senate this week. Remember that the DSH, or Disproportionate Share Hospital, program, is designed to reimburse hospitals with a larger population of uninsured or charity cases. Efforts are being made to reform and revamp the DSH program. In other legislative news, lawmakers are looking to repeal and/or extend the delay of the medical device tax.
The FDA might have a new head soon.
Finally, Trump is expected to nominate Stephen Hahn as the next FDA commissioner.
Policy Corner, week of October 14
Revamping Stark and Anti-Kickback laws for the first time in 30 years.
There’s a ton of regulation that dictates what physicians can and can’t do with patient referrals, and what they can and can’t get paid for when they’re employed. The Stark and Anti-Kickback statutes are the most important of these regulations, and these rules were put in place to protect patients and shield them from any providers that put their own greed above the needs of patients.
Remember when we talked about the transition to value-based care earlier, though? Well, the problem is that those old laws were designed for the fee-for-service reimbursement system – meaning that physicians are paid for services rendered (1 visit for $100; 1 x-ray for $50; etc. – you get the idea). There are still a lot of fee-for-service arrangements out there, but quite a few plans between providers and payors are transitioning to value-based arrangements.
As compared to fee-for-service, there’s a lot of variation between different value-based plans. The variation has caused a lot of confusion when it comes to Stark and Anti-Kickback laws, since the way physicians are paid changes so much. Additionally, the old laws have probably prevented some new, innovative value-based arrangements from taking shape in the first place.
Since value-based payments have gained a lot of steam, HHS decided it was time to revamp the Stark and Anti-Kickback statutes to provide more clarify on what providers can and can’t do.
Read more about the potential implications of the changes here.
MORE: What are the other headwinds involved in the “volume to value” transition?
Public charge rule, which included Medicaid as determinant, blocked by judge.
This week, a federal judge blocked the White House’s contentious Public Charge rule, which would have used Medicaid as one of several public programs to consider denial of green cards to immigrants based on how many ‘public resources’ that immigrant used.
New Trump rule would require migrants to have un-subsidized health insurance to enter U.S.
In a new development, the Trump administration plans to suspend migrant entry into the U.S. if that individual would financially burden the U.S. healthcare system. If upheld, that policy would take effect on November 3. Migrants would have to prove that they have some form of valid insurance – and subsidized ACA plans don’t count. Valid forms of health insurance include employer sponsored coverage, un-subsidized ACA plans, Medicare, and a few others.
Louisiana Abortion Case makes its way to Supreme Court.
The Supreme Court is pegged to hear an abortion case in Louisiana – June Medical Services v. Gee. The case surrounds whether it’s legal for a state to require a doctor performing an abortion to have admitting privileges at a nearby hospital.
The Latest Drug Pricing Stuff. Buttigieg’s proposal, and PhRMA claps back against Pelosi’s plan.
This week, presidential candidate Pete Buttigieg released a very ambitious drug pricing plan that would create a new public option (similar to plans we’ve seen unveiled at the state level like in Washington). Both this new public drug plan and Medicare would have the ability to directly negotiate drug prices with pharmaceutical companies, put a tax on those pharmaceutical companies, and cap out of pocket spending for both plans in the low hundreds of dollars.
Finally, read what the PhRMA CEO had to say about Nancy Pelosi’s drug pricing proposal. A small highlight: “If H.R. 3 becomes law, it is lights out for a lot of very small biotech companies that are pre-revenue and depend on attracting capital.”
Policy Corner, week of October 21, 2019: Medicaid Work Requirements cost States Millions, Pelosi’s Drug Plan passes through Key House Committee, Elizabeth Warren gets pressed on Healthcare, and an Update on the ACA in Court.
Medicaid work requirements are apparently costing states millions.
Requiring people to work in order to receive Medicaid was a contentious issue when first unveiled in states like Arkansas. In theory, it sounded like a solid proposal – contribute to your local economy, and get rewarded with Medicaid coverage / public welfare.
Then, questions arose about the implementation of said proposal. How would the reporting work? Who would hold the individuals accountable? Not to mention scrutiny the policy received from court. No one really knew whether the work requirements were ‘working’ (haha) or not.
This week, we received the first data point: a federal report indicated that Medicaid work requirements are actually costing states millions based on the administrative costs required to run these programs.
Read the full federal report here.
Pelosi’s Drug Pricing Plan Update.
A few more developments emerged from the Pelosi Drug Pricing camp this week (which still has no chance of passing the Senate as long as Mitch McConnell is around). The drug pricing bill advanced through the House Energy and Commerce Committee, but still must pass through 2 more committees before it reaches the floor.
In other news, the Congressional Budget Office released an analysis of the drug pricing proposal, finding that the plan would potentially save Medicare around $370 billion over 6 years by imposing price controls.
Democrats were huge fans of this news, while Big Pharma and Republicans stressed that any proposal that reduced drug revenues this drastically – estimated between $500 billion and $1 trillion – would result in severely less innovation for new drugs entering the market.
While the bigger pharmaceutical companies would most likely survive, the smaller biotech incubators rely on a lot of early stage financing from investors willing to invest in risky assets. If the reward were to become much more muted, would this investment in biotech small caps still happen? Of course, this is all hypothetical.
Other Policy Updates – 2019’s remaining agenda, Elizabeth Warren gets pressed on healthcare, and keep the looming ACA ruling in mind.
Here are Congress and the White House’s healthcare initiatives to keep an eye on as 2019 comes to a close (where does the time go??). In case you missed it, here’s our timeline of Surprise Billing updates for 2019.
Elizabeth Warren received some flack (paywall – WSJ) for her lack of detail with her Medicare for All proposal, including how the plan would be funded. She’s expected to release some information soon after dodging questions about it in the debate this week. Read more background here.
Finally, keep in mind that the ACA ruling is expected to happen any day now (paywall – WSJ). Some states are scrambling to keep the ACA in place until a new health law is formed. The White House also has indicated continual support for the ACA until a replacement takes shape (that is, if the law gets struck down).
Policy Corner, week of October 28, 2019: Vaping Ban? Healthcare Lobbying shoots up, the FTC wants to review the effects of hospital mergers, and CMS might start using AI for fraud.
All about Vaping: potential Vaping van is being considered (smoking is fine though, no worries), and a Vaping Tax Bill on the House Panel.
House Ways and Means committee is considering a vaping tax bill this week. The bill would tax vaping products at the same level as tobacco products.
Not to be outdone, the FDA is actually about to ban flavored e-cigs for good. This ban would exclude mint and menthol flavors (thank goodness) and is coming on the heels of over 1,600 vaping related mysterio-illnesses.
The FTC wants to take a closer look at Hospital Mergers
This week, the Federal Trade Commission phoned a few hospital friends along with major insurance companies to request data on recent mergers and acquisitions. The agency is really trying to hone in on certain states with certificates of public advantages (COPA) – namely, Tennessee, Virginia, and West Virginia – states with large rural areas. In particular, the FTC wants to research whether COPAs are good for the public or not.
What’s a COPA?
States can use COPAs to shield hospital and health system mergers from federal regulations and monopolies (basically, they take the merger approval into their own hands and keep the feds away from the transaction altogether).
Why would the states ever issue them?
It’s a bit tricky in healthcare (what’s new, right?). In most cases, states issue a COPA for a transaction because the merger is taking place in a rural area. Most of these states have large rural areas and want to keep those hospitals open. It doesn’t help that rural hospitals have been really struggling lately.
So, in an attempt to keep these rural hospitals alive, states have been allowing monopolies in these markets to have hospitals rather than none at all. There’s also no way any of these communities could support two hospitals, so introducing competition is simply out of the question.
It might not an ideal solution, but here’s how it works – a larger local health system comes in and purchases the struggling rural operation. States shield the transaction from federal antitrust oversight and allow the merger. Then the local rural community keeps its hospital, and maybe the health system benefits if it turns operations around.
Healthcare Lobbying pushes higher.
How much did the different healthcare trade organizations spent on lobbying this quarter? Glad you asked.
PhRMA (3 guesses on which industry they rep) spent $6.2 million as drug pricing legislation bounces around Congress to no avail (currently)
- Amgen: $3 million
- Bayer: $2 million
- AbbVie: $1.8 million
- Pfizer: $1.6 million
- Gilead Sciences: $1.5 million
Meanwhile, don’t forget about the surprise billing lobbying blitz happening at the other end of the healthcare world, totaling $4.1 million in lobbying spending in the third quarter alone.
In the miscellaneous category…
Carcinogenic breasts: The FDA might require breast implant manufacturers to post cancer warnings on its labels.
Rural ACOs get a lift: Senators are considering boosting payments to rural ACOs
ACA Replacement Republican Healthcare Plan? Here’s a quick writeup on what any possible ACA replacement might look like from the Republican party. Main takeaway: give more regulatory power to the states, save pre-existing conditions, and give Medicaid block grants. Read the full report here.
Big win for payors: The U.S. was just ordered to cough up $1.59B in subsidies to Kaiser, Oscar, and other payors
AI and Fraud Detection: And finally, the CMS is looking to use artificial intelligence to help with fraud – especially in home health, where fraud can be rampant.
Healthcare Policy Corner, week of Nov 4 – Democratic candidate plans challenged, price transparency delayed, site-neutral payments march forward
Medicare For All plans from Warren, Sanders get challenged
Although Elizabeth Warren and Bernie Sanders both really want Medicare for All to be a thing, they’re getting attacked from all angles (even SNL). Their fellow candidates (AKA Biden, Buttigieg, others) are seizing the moment and challenging certain aspects of the individual plans, especially Warren’s. Read what Biden’s camp had to say about her health plan:
“Her plan would create a new tax on employers of almost $9 trillion that would come out of workers’ pockets, a new financial transaction tax that would impact investments held by middle class Americans, and a new capital gains tax that would affect far more people than she stated tonight,” Biden said in a statement on Saturday.
Meanwhile, Bernie, while less in the spotlight currently is mumbling in the corner about not having to explain how he’s planning to pay for the estimated $30 trillion policy proposal.
Trump Administration gets cold feet on price transparency rule.
In a big win for providers, the Trump Administration delayed its hospital price transparency proposal, which would have forced hospitals to disclose negotiated rates with insurers to the public.
CMS says screw federal judges, we’re doing site neutral payments. AND we’re cutting 340b payments.
In other CMS news, the agency is planning to move forward with site-neutral payment policy despite losing a court case on the matter earlier this year.
In a double whammy to hospitals, they’re also slashing 340b payments, which is a program designed to reimburse hospitals for drugs used on poor and underserved populations.
Read the ModernHealthcare article covering both policies here.
Federal judge blocks immigration rule that would have required immigrants to show they have or can afford health insurance
Finally, remember that healthcare rule that would have required new immigrants to prove that they had healthcare before being approved? A federal judge blocked that bad boy this week.
Policy Corner, week of November 11, 2019. Medicare for all loses appeal, CMS 2020 final ruling roundup, Trump nominates Stephen Hahn as next FDA head
Medicare For All loses appeal in recent months.
Last week, we touched on how Warren’s and Sander’s Medicare for All plans were getting attacked by their fellow Democratic candidates (Biden, Buttigieg).
Now, Nancy Pelosi is joining on the fun – as it turns out, she’s not a big fan of Medicare for All, either.
Finally, Pete Buttigieg chimed in with his healthcare plan this week, calling it “Medicare for All who want it.” Creative.
At the state level.
What’s more telling is what’s happening in state elections.
Democratic incumbents are shying away (WSJ paywall) from Medicare for All rhetoric, which signals that they don’t think it’s a viable or popular policy to run for re-election on – OR, they don’t want to be associated with Warren/Sanders camps.
It makes sense – healthcare is such a huge employer in most every market. Would voters approve of a policy where their jobs might be at stake?
The risk might not be worth it when they have easy healthcare talking points to Democratic voters, like Medicaid expansion and keeping preexisting conditions.
Pelosi’s drug plan is getting ghosted by the White House.
The White House isn’t really on board with Pelosi’s drug plan, and is distancing itself from the policy. Maybe they have something better in mind. Like surprise billing, drug pricing is in complete gridlock.
Medicaid Work Requirements screech to a halt.
Kentucky, Indiana, New Hampshire, and Montana all are ending their Medicaid work requirements programs for various reasons. Indiana is pausing its program as another court case challenging its Medicaid program makes its way through the legal system.
Meanwhile, Kentucky’s new governor isn’t a fan of work requirements either. The night Beshear won (I guess that’s still up for debate though?), he promised to get rid of the policy.
Finally, Montana delayed its plans to enact work requirements on Jan. 1, along with New Hampshire, which found that less than a third of people under work requirements were in compliance with the program.
Proposed price transparency ruling from the Trump admin expected by the end of the year
While it wasn’t included in the final ruling for the Medicare physician fee schedule, ModernHealthcare reports that the Trump admin is still expected to release an updated proposed ruling on the ever-contentious price transparency policy. Stay tuned…
Trump Nominates Stephen Hahn to head FDA.
As we all expected, Trump nominated renowned cancer doctor Stephen Hahn for FDA commissioner
Policy Corner, week of Nov 18: Trump Admin releases big-time price transparency rule
The Trump administration’s finalized ruling for price transparency was released on the 15th. Actual enforcement of the final ruling starts in January 2021, but there’s absolutely no question that it will be aggressively challenged in court.
Details of the price transparency rule.
Like we mentioned back in July, the rule will force hospitals to disclose reimbursement rates by insurer for 300 common procedures in a machine readable format. Common procedures would include things like birth, outpatient surgeries, certain gastrointestinal exams, and more.
They’ll have to pay a $300 per-day fine if they choose not to release the info, which amounts to $110k per year. About the salary of an IT guy.
As you can imagine, this ruling is extremely contentious among payors and providers. Some experts don’t even think the finalized ruling is legal. Hospitals have already promised to take the Trump admin to court.
Lots of controversial topics this week, eh? Told ya healthcare isn’t boring.
Here’s the finalized rule
Here’s the other proposed rule that would affect health insurers.
Trump Admin delays the Vaping Ban.
In another twist this week, Trump is planning to delay the vaping ban after hearing from the industry and users. While the administration wants to keep vapes out of the hands of children, Trump has also commented on vaping’s effectiveness in getting people to quit smoking. And the last thing Trump wants to do in an election year is to hurt any jobs growth through vaping regulation
Policy Corner, week of November 25
Surprise Billing and Drug Pricing Update: No progress.
As we all know, Congress’ main healthcare objectives during the fall session were to curb surprise billing and make progress on decreasing drug price inflation.
As the impeachment proceedings suck up legislative time, it’s unlikely these issued get resolved in 2020. Bipartisan deals are probably a bit hard to come by right now.
Congress once again delays DSH cuts.
As a part of the broader budget deal, the House pushed back Medicaid DSH cuts (i.e., the program that pays back hospitals who see a lot of charity care patients) until December. Remember that the ACA initially wanted to phase out these payments by 2025.
In its final rule this year, CMS already laid out a roadmap to reduce DSH payments as compelled by the ACA, but Congress keeps intervening and delaying the cuts. I would look for potential reform to the disproportionate share hospital program in 2020.
Right now, DSH is paying out around $18.1 billion to over 3,000 hospitals.
Hospitals sue HHS over alleged underpayments.
Over 600 hospitals just sued HHS over an a few billion dollars in underpayments.
They claim that HHS illegally reduced inpatient hospital reimbursements starting in 2017 and continuing into 2018 and 2019
FDA nominee testifies.
Stephen Hahn, the current FDA nominee, testified (WSJ paywall) in front of a Senate panel this week.
The panel focused in on whether he’d be willing to combat vaping as well as fight drug prices. He’ll most likely be confirmed by the end of 2019.
Policy Corner, week of December 2nd
HHS and CMS are Butting Heads
Health and Human Services Secretary Alex Azar and CMS chief Seema Verma seem to be clashing quite a bit in the Oval Office, according to Politico’s anonymous sources. The story goes as far as suggesting that Azar is trying to push Verma out. That’s some high school level drama, eh?
The bitter rivalry is causing a deep rift in Trump’s healthcare administration, and seems to be holding back policy – like drug pricing or surprise billing – from taking shape.
Regulatory | Vaping
Trump Doesn’t Want to Risk Vaping Ban
Amidst the health concerns surrounding vaping and the continued push for a permanent ban, researchers are saying “hold up.” They think that vaping could actually help people to quit smoking and that the fake smoking device needs more time and research to consider it as an alternative to smoking. Which kills, in case you forgot.
We’re also forgetting the potential political implications of an outright vaping ban. About 10% of Trump’s constituency vapes. I’m sure he’s just gonna ignore that and ban vaping, anyway.
Read this: Trump’s vaping ban puts him at political risk – an estimated 10% of his supporters vape. We get it.
Medicaid | Tennessee
Tennessee Wants to Overhaul Medicaid
Tennessee has found itself as the guinea pig over the future of Medicaid in a highly controversial proposal. In a first for any state, Tennessee asked the federal government for a ‘block grant’ lump sum to fund its Medicaid program, rather than the ‘pay as you go’ program currently funded by the federal government. What ultimately gets decided in court may shape the future of the welfare program. Read the article for yourself and see what’s going on.
Payment Models | Radiation Oncology
CMS Delays the Radiation Oncology Payment Model
This week, CMS, who’s in charge of how much Medicare pays for health services, delayed its controversial payment re-design for the radiation oncology industry (that’s people who receive radiation treatment for cancer).
In other news, CMS also wants to revamp primary care payment models. Through Direct Contracting, CMS wants larger physician groups to take on more risk, a-la, “value-based” arrangements.
Policy Corner, week of December 9th
Hospitals | Price Transparency
Hospitals Want to Block Price-Transparency Rule
As we all expected, hospital groups officially sued the Trump administration over the contentious price transparency rule, under which they would be forced to disclose how much insurance companies pay them for healthcare services.
The arguments.
The hospital defense: Revealing negotiated rates made between the hospital and the insurer will confuse patients, take a large financial toll on hospital IT departments retrieving the data, and hurt competition by potentially causing collusion – or even higher prices when certain hospitals see they’re getting underpaid.
There’s even a free speech argument: is the forced disclosure of highly confidential prices in a business operation a violation of that company’s free speech?
Re-calibrate yourself: Remember that HHS tried to pass a similar law with drug prices earlier this year, which would have required drugmakers to disclose list prices of drugs on TV commercials for any medication over $35. A judge struck down that rule, saying that HHS didn’t have the proper authority to impose that kind of regulation – so who knows if HHS has the authority over hospitals and this ruling, either.
From Seema Verma’s Op-Ed in the Chicago Tribune, she thinks the hospitals’ arguments are pretty weak and advocates for transparency.
What do you think?
Regulatory | Drug Policy
U.S. Considers Easing Drug Protections to Break Logjam Over Trade Pact
WSJ reported (paywall) this week that the Trump administration is “considering scaling back intellectual-property protections for big drug-makers to help win Democratic support for a new trade pact with Mexico and Canada.”
Why this matters.
A big way that drug-makers maintain revenue growth and margins is through enjoying exclusive rights to the drugs they develop for a number of years. That exclusivity period might shrink if this proposal is included in the new NAFTA trade pact, which would affect profitability.
Other drug stuff to know:
FDA Head Approved: The Senate panel approved Stephen Hahn, Trump’s FDA head nominee. Next up: a full Senate floor vote.
Pelosi Update: The White House thinks Nancy Pelosi’s drug pricing proposal (read about it here) would cost $1 trillion annually and stifle the development of up to 100 drugs per year. Breaking: the plan isn’t going anywhere anytime soon.
Policy | Medicaid
Medicaid Work Requirement Delayed Everywhere
State lawmakers are either delaying or cancelling Medicaid work requirements everywhere – Indiana, Virginia, New Hampshire, Michigan, Montana, and Arizona – just to name a few states. As it turns out, it’s far more costly to track whether or not people are in compliance than it is to just give them Medicaid benefits.
You should also know: legal challenges are mounting against Medicaid work requirements, which is also partly why several states suspended their programs for the time being.
Policy | 2020 Election
Latest Healthcare Election News
From the Warren Camp: How a fight over healthcare entangled Elizabeth Warren and reshaped the Democratic race
The Voice of the People: Do voters really want all of the focus to be on healthcare in 2020?
Finders, Keepers: Joe Biden thinks Pete Buttigieg, who has surged in popularity in recent months, stole his healthcare plan.
Say Bye Bye, Kamala: The California Democrat dropped out of the running this week. That means one less healthcare policymaker to track for me.
Racist Algorithms: Cory Booker wants the FTC to look into biased healthcare algorithms.
Rural Health: Is it becoming a major 2020 campaign issue?
Policy Corner, week of December 16th
Legislation | Surprise Billing
Providers Lose Out in Latest Bipartisan Surprise Billing Draft
What’s New: Bipartisan leaders in Congress in both the House and Senate drafted a bill to combat surprise billing.
Details of the Surprise Billing Bill.
The new bill is an altered version of older proposals. For bills under $750, insurers would pay providers at least the median in-network rates for that region. You might have seen reporters call this the “benchmark rate” method. For bills over $750, insurers and providers will negotiate through a third party – called the “arbitration” method.
Who Wants What.
Providers oppose the benchmarking part of the deal. They think the bill will lower reimbursement by giving them less room for negotiation (it will).
Insurers oppose arbitration because their negotiating leverage for larger costs goes out of their hands. So, since nobody’s happy, the bill is probably closing in on the right solution.
You should know: New York tried 3rd party arbitration to combat surprise billing in 2015. The catch? The bill guided arbitrators to use use the 80th percentile of billed charges as the starting point.
Here’s the problem with that: charges are generally made up numbers and do not correlate to actual reimbursement. Providers charge a certain amount for healthcare services but receive lower reimbursement from insurance/patients. As a result, providers ended up receiving higher payments in New York.
If Congress pegs the arbitration to a high level of charges like New York did, insurers could lose out big time. But it’s important to note that the national bill is different because it includes benchmarked rates.
Conclusion.
- Who loses: Providers
- Who’s in the middle: Insurers
- Who wins: Patients
Keep in mind that this bill, while bipartisan, still has a long way to go – especially since a House panel just introduced a rival proposal. But these same solutions have been floating around Congress for a while now.
Go Deeper From Bloomberg: Patients and insurers are the big winners in the latest surprise medical bill deal.
ACA | Supreme Court
SCOTUS Leaning Toward Insurers in Latest ACA Legal Battle
The ACA is back in the Supreme Court. This time, big insurance companies are accusing HHS of pulling a classic bait-and-switch.
Details.
The insurers claim that HHS promised to subsidize certain ACA plans if insurers entered that market. Unfortunately, Congress defunded this part of the ACA, and insurers weren’t paid. Cue insurance companies suing HHS for $12 billion.
Important: Remember to distinguish THIS case from the from the other ACA case, where the courts are assessing whether the ACA is still constitutional after Congress dropped its individual mandate clause at the end of 2017, which previously had required everyone to have insurance coverage or face a fine.
Other ACA Updates: The latest government spending bill is expected to remove two of the ACA’s more controversial taxes – the medical device tax and the Cadillac tax. Also in the deal? Raising the tobacco age limit to 21.
CMS | Insanity
A Counseling Session for Healthcare Leaders
In what has been described as a “f******” soap opera (fill in the blank), White House officials have been mediating counseling sessions between HHS head Alex Azar and CMS head Seema Verma. Speaking of Ms. Verma, she’s had quite the week:
Ironic Timing: Modern Healthcare named Seema Verma healthcare’s #1 most influential person in 2019.
You should see yourself out: Joe Kennedy wants CMS Head Seema Verma to resign after reports surfaced that she had asked taxpayers to reimburse her for $47k related to stolen jewelry on a work trip. Charges were, of course, dropped for insufficient evidence.
This story was allegedly leaked by HHS officials, which goes to show the relationship both sides have with one another if that turns out to be true.
From the WSJ, certain CMS employees are now accusing HHS of sexism. Quotes from the article:
“We call the sixth floor the ‘tall white men’s club.’ …This is so much bigger than these little stories. HHS is no longer a safe environment.”
HHS reps disagreed. “HHS is one of the most friendly places for women.”
Conclusion: I wouldn’t want to work there.
Policy | 2020 Election
Latest Healthcare Election News
From Politico: Andrew Yang’s six-step plan for healthcare. Hint: it doesn’t involve Medicare for All.
Drug Pricing: House Democrats passed Nancy Pelosi’s drug pricing bill. Even though it’s dead on arrival in the Senate, it shows how Democrats are thinking about drug pricing going into the 2020 election.
Details of the bill: direct government negotiation of drug prices, strict inflation controls, and interestingly, expansion of Medicare to cover dental, vision, and hearing.
Vapers: Will the vaping demographic swing the 2020 election?
Divergence: Republicans and Democrats are far apart when it comes to healthcare. In my brief experience, healthcare views tend to get politicized pretty quickly, so this poll’s results make sense.
Political Risk: A reported by Axios, if the ACA is repealed, Trump might lose out big time politically because the most affected states are ones that typically swing presidential elections.
On to the Democrats.
Read a summary of Democratic candidate healthcare positions here.
Andrew Yang: Read his healthcare plan.
Elizabeth Warren: Shifted her rhetoric to emphasize voter ‘choice’ in healthcare insurance plans. She thinks that once her public option 100 day plan gets a trial run, voters will choose it over private options.
Joe Biden: Is a “healthy, vigorous” male at age 77. Good for him.
Michael Bloomberg: Joins the Public Health Option bandwagon
Policy Lingo: What’s a “Public Health Option” all these candidates are talking about?
From the Debate: Candidates wondered whether Medicare for All is realistic, but healthcare wasn’t discussed much at this one.
Big ACA News: Appeals Court Decides Individual Mandate is Unconstitutional
An appeals court officially struck down the individual mandate during Q4. HOWEVER, they left the decision of the legality of the ACA up to the court that made the original ruling.
Bottom Line.
Most experts think that the ruling is on faulty footing. They argue that the individual mandate was removed in 2017 with Trump’s tax cut, and the ACA continued on, business as usual. Anyway, see you guys in the Supreme Court. That case will be expected to hit in late 2020 – which means healthcare will stay front and center during Election 2020.
Read more: HHS’ and healthcare groups’ responses to the news.
Healthcare Spending Bill
Spending Bill Surprises: A recap of all of the healthcare policies changing in Congress’ $1.4 trillion spending bill.
- ACA tax repeals
- Tobacco age to 21
- More U.S. HIV funding
- Promote generic drug competition
- Gun violence funding
- Suicide prevention funding
- Extending DSH payment delays
- Funding U.S. territory Medicaid services
- Read more on the spending bill here
More on those healthcare tax repeals…
The U.S. spending deal repealed insurance and medical device taxes.
According to a non-partisan analysis, those repeals are expected to decrease tax revenues by $373 billion over the next 10 years. Remember that these taxes weren’t ever in effect – but would have phased in in 2020 or soon thereafter.
Conspicuously missing from the spending bill…
Two major Congressional healthcare agenda items were left out of the December spending bill: surprise billing and drug pricing legislation. So let’s touch on the state of surprise billing next.
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