HealthCare Roundtable e-News – August 15, 2022

 

Top News

House Passes Inflation Reduction Act, Sending it to President Biden’s Desk

Friday, the House passed the Inflation Reduction Act by a vote of 220-207. Significantly scaled down from the original Build Back Better plan, the legislation focuses on health care, climate, and taxation.

The Inflation Reduction Act includes $64 billion to extend Affordable Care Act (ACA) tax credits for three years through 2025. Additionally, the legislation allows Medicare to negotiate the cost of certain, commonly used prescription drugs. The provisions of the legislation that would penalize drug manufacturers for raising the cost of drugs at a faster rate than inflation were trimmed. The Parliamentarian ruled that the inflationary rebate provisions could not apply to the private market and that the penalty may only be applied to Medicare.

Furthermore, the legislation caps out-of-pocket costs at $2,000 annually for Medicare beneficiaries starting in 2025, and requires coverage of vaccines with no-cost sharing under Medicare Part D beginning next year. Last week, Senate Democrats also added insulin-affordability measures. Their proposal to cap out-of-pocket prices at $35 a month for Medicare remained intact, but the measure failed to apply to the private market.

 

Federal Courts Rule in Two Cases Disputing Provisions of No Surprises Act

Federal judges in New York and Texas handed down decisions in two cases disputing interim rules related to the No Surprises Act. The legislation, which went into effect this past January, limits the amount providers can bill patients for emergency services delivered by out-of-network providers, or non-emergency services delivered by out-of-network providers at in-network facilities.

The Department of Health and Human Services (HHS) overcame a New York surgeon’s challenge to the No Surprises Act. A federal court determined that the law’s provisions do not violate the doctor’s constitutional right to a jury trial by requiring providers to engage in administrative arbitration proceedings against patients’ insurers to collect money owed for their services. Last month, a federal judge in Texas sided with an air ambulance provider and invalidated parts of a rule related to the No Surprises Act. The decision tosses out rules for the arbitration process that the court believes unfairly favor health insurers in administrative proceedings.

Administrative Action

  • Health and Human Services (HHS) Secretary Xavier Becerra issued a determination under Section 564 of the Federal Food, Drug, and Cosmetic Act, which will allow the Food and Drug Administration (FDA) Commissioner to grant emergency use authorizations (EUA) for monkeypox vaccines. Secretary Becerra’s determination comes less than a week after he declared a Public Health Emergency (PHE) last Thursday.

  • The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded nearly $90 million in American Rescue Plan (ARP) funding to nearly 1,400 community health care centers to advance health equity through better data collection and reporting. According to HHS, in 2021, HRSA-funded health centers care for one-in-five residents in rural areas and one-in-eleven people nationwide. One-in-three health center patients are living in poverty, and nearly two-thirds are racial/ethnic minorities.

  • The Department of Health and Human Services (HHS) Department Office of Environmental Justice, The Centers for Disease Control and Prevention (CDC), and the Agency for Toxic Substance and Disease Registry (ATSDR) released the Environmental Justice Index (EJI), a nationwide environmental justice score. The EJI uses data from four federal agencies, including the U.S. Census Bureau, to rank impacts of environmental injustices in communities. The goal of the EJI is to view environmental and health impacts from an equitable lens, providing a framework to create innovative solutions that help underserved communities.

Congressional Action

The Washington Post Live “Across the Aisle,” Series held a webinar event with Reps. Ann Kuster (D-NH) and Brian Fitzpatrick (R-PA) to discuss their bipartisan mental health legislation. The discussion, moderated by Leigh Ann Caldwell, allowed both Representatives to discuss the importance of the legislation, as well as their efforts to pull bipartisan support. Reps. Kuster and Fitzpatrick emphasized the need for this legislation to address the revolving door of mental illness in the law enforcement system, mental health in schools, and benefitting the workforce. Additionally, they highlighted the role of trauma, social isolation, and the co-occurring nature of substance use disorder and mental illness.

Medicare

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report examining the cost impact of Medicare Part D plan’s preference for a higher-cost hepatitis C drug. OIG found that following the introduction of authorized generic versions of two brand-name hepatitis C drugs – Epclusa and Harvoni – in 2019, use of the generic versions increase in Medicaid at greater rates than in Medicare Part D. Notably, in 2020, some Part D plans did not cover the authorized generics at all. As a result, Medicare beneficiaries were less likely to use the other lower-cost brand-name options. Medicare spent about $155 million more in catastrophic coverage payments for the higher-cost hepatitis C drugs, despite a similar number of beneficiaries in each cost group reaching catastrophic coverage.

Marketplace

The Centers for Medicare and Medicaid Services (CMS) sent a letter to the office of Georgia Governor Brian Kemp suspending the state’s plan to cease use of Healthcare.gov and other federal enrollment outreach efforts for its individual insurance market. The Georgia Access Model would have relied on private insurer agents and brokers to connect enrollees with plans. Critics of the plan argued it would likely reduce enrollment, leading to CMS’ decision to suspend the program. According to the letter, Georgia sent a response to CMS in July disputing enrollment projection.

Research

study from the University of Michigan identified several structural barriers to social capital in Detroit, Michigan, and identified opportunities for the local government and community organizations to capitalize in order to promote economic development. The study found that a lack of connections within the family unit and the larger community left community members feeling as though they lacked economic mobility or confide in for personal problems. The study recommended further investment in community organizations and spaces designed to provide connection and mentorship. Additionally, the study recommends that local government integrate social development into program models to assist in developing economic mobility and growth, while increasing access to social service information.

Roundtable Reminders

SAVE THE DATE – November 9-11, 2022
Annual Conference Returns to Alexandria, VA

After two years of virtual meetings, the Roundtable is planning an in-person Annual Conference for this November. We will return to The Alexandrian Hotel in Old Town Alexandria, Virginia for our annual policy conference from Wednesday, November 9 to Friday, November 11, 2022.

Details will be released later this year. For now, save the dates!