Today's News and Commentary

About health insurance

CBO: Senate surprise billing legislation would save feds $7B over next decade: The Senate Health, Education, Labor and Pensions Committee asked the Congressional Budget Office for estimates on the financial impact of its proposal to address surprise medical bills and high pharmaceutical costs. The CBO reported that the law would lower federal expenses by $7 billion over the next decade. A closer look (Table 1) reveals that that savings do not start until 2025. By 2028 the net federal budget savings reaches about $4.5 billion.

Democratic chair: Medicare negotiating drug prices not moving before August: On the House side, it appears that drug price legislation will not happen before the August recess.

New CMS resources help states waive ACA requirements: The ACA has provisions to grant states waivers (Section 1332) to adopt alternative schemes to provide health insurance. “Most states have gotten or are seeking the Section 1332 waivers to establish a reinsurance program to fully or partially reimburse insurers that are covering claims for high-risk beneficiaires. This reduces the price of premiums in those states.” CMS has just issued guidelines to make the waiver process easier. The question that arises is what happens to insurance markets as the number of products increase and enrollees segment themselves among these plans by financial and health status criteria?

Trump Administration Moves to Shift Patients’ Chronic Illness Costs to Insurers: In order to have a Health Savings Accounts (HSAs), participants must also have a high deductible health plan. These plans require large out of pocket payments before the insurance becomes responsible. The Internal Revenue Service and the Treasury Department just issued a guidance for high-deductible health plans that allows insurance companies to pay for such chronic disease items as glucose monitors and blood pressure cuffs without first satisfying the deductible. This type of allowance has been discussed before with respect to total coverage of chronic medications to ensure compliance.

Insurers Running Medicare Advantage Plans Overbill Taxpayers By Billions As Feds Struggle To Stop It: Payments to Medicare Advantage plans include adjustments for the severity of illnesses of covered persons. CMS clams that over the past three years these plans have overbilled Medicare $30 billion. The controversy over this issue is whether plans are documenting better or exaggerating patient findings. We will see which is true when the government seeks to recoup the money it claims plans owe.

Early Effects of an Accountable Care Organization Model for Underserved Areas: In its first year, the Accountable Care Organization Investment Model "was associated with a differential reduction in total Medicare spending of $28.21 per beneficiary per month relative to the comparison group, which amounted to an aggregate decrease of $131.0 million…” After accounting for “$82.4 million in CMS spending, the aggregate net reduction was $48.6 million, which corresponded to a net reduction of $10.46 per beneficiary per month. Decreases in the number of hospitalizations and use of institutional post-acute care contributed to the observed reduction in overall spending.”

Health Insurance Index Report for the 2019 Open Enrollment Period: This report from eHealth found that, for unsubsidized enrollees in exchange plans, the average premiums for two-person families broke $1,000 per month for the first time and the total “combined annual premiums plus deductible for a four-person family now tops $25,000.” The good news is that for 2019 the “average individual deductible decreased 6%…” and the “average family deductible decreased 8%…”

About the public’s health

Unintentional Injury Death Rates in Rural and Urban Areas: United States, 1999–2017: We pay much attention to diagnosis and treatment of diseases such as cancers and heart attacks; however, according to the CDC, unintentional injury is a leading cause of death in the United States. In this category are traffic accidents, unintentional drug overdoses, and falls. In this July report, the CDC says that from” 1999 through 2017, the age-adjusted unintentional injury death rate increased 40%.” Clearly more attention needs to be directed at this category of deaths.

Planned Parenthood ousts leader after less than a year: Normally a job change is not big news. However, this ouster was caused by the Monday start of the rule prohibiting federally funded family planning clinics from providing referrals for abortions. Apparently former president Leana Wen, MD wanted to approach the issue as a medical one while the organization saw it as a political fight. In related stories, two Planned Parenthood clinics (in Illinois and Maine) said they would refuse federal funding so they could continue to provide abortion services.

76 billion opioid pills: Newly released federal data unmasks the epidemic: This Washington Post story details the magnitude of opioids that have been flooding the market and the role played by pharma companies and the manufacturers which supply them. This information comes from the public release of data from the Drug Enforcement Administration. The question now is not about who produced and promoted what drugs, but why the DEA was sitting on data that clearly showed an epidemic in the making.

Trump to order drive for improved flu vaccine: Now some good news. After years of questioning the safety of vaccines, President Trump “is readying an executive order that would direct HHS to overhaul the development of flu vaccine and encourage more Americans to get vaccinated.”

Incentives for smoking cessation: The best way to get people to stop smoking is to raise cigarette taxes. But does paying them to stop also work? This Cochrane Collaborative article concludes that: “Six months or more after the beginning of the trial, people receiving rewards were more likely to have stopped smoking than those in the control groups.” The amount did not matter.

New York City Hopes to Ease Strain on Its Emergency Rooms: NY City has announced an expanded primary care system called NYC Care. It is expected to serve 300,000 patients and reduce ER usage by providing a regular source of care.

About pharma

Johnson & Johnson lifts annual revenue guidance as Q2 drugs sales top estimates, led by Darzalex, Imbruvica, Tremfya: Despite the pending liability suits over opioids and asbestos in baby powder, and pressures from generics, J&J continues to be profitable. This is article provides a good look at the importance of a diversified product line.