HealthCare Roundtable e-News – June 22, 2021


7-2 Supreme Court Ruling is a Victory for Obamacare, But Leaves Room for Future Suits

Last Thursday, the Supreme Court voted to dismiss the high-profile case of California v. Texas, overturning a federal court’s decision that the Affordable Care Act’s individual mandate is unconstitutional. The suit was backed by the state of Texas and 20 other Republican governors and attorneys general, with Democratic attorneys general—led by now-HHS Secretary Xavier Becerra—and the House members looking to appeal an initial decision by the Fifth Circuit to the Supreme Court.

The suit was largely backed by the Trump administration after Federal Judge Reed O’Connor agreed with the plaintiffs, citing that the ACA’s individual mandate is invalid and inseverable from the rest of the law. The decision to scrap the law was dependent on multiple appeals court hearings. With the Supreme Court agreeing to hear the case in March 2020, many Democrats and other defenders of the ACA worried that the Supreme Court’s conservative majority would vote in favor of scrapping the law. (InsideHealthPolicy)

“We conclude that the plaintiffs in this suit failed to show a concrete, particularized injury fairly traceable to the defendants’ conduct in enforcing the specific statutory provision they attack as unconstitutional…Neither the individual nor the state plaintiffs have shown that the injury they will suffer or have suffered is ‘fairly traceable’ to the ‘allegedly unlawful conduct’ of which they complain,” wrote Justice Stephen Breyer in the court’s decision. Chief Justice John Roberts supported the opinion, as did Sonia Sotomayor, Elena Kagan, and conservative Justices Clarence Thomas, Brett Kavanaugh and Amy Coney Barrett. (InsideHealthPolicy)

In their dissent, Justices Samuel Alito and Neil Gorsuch said that further legal action against the ACA is still possible. Both justices wrote that if the case is dismissed for lack of jurisdiction, the states can file a new action, and the “Affordable Care Act may go on.”

Wyden Asks Becerra About Need for Value Assessments in Drug Price Negotiation

During a hearing that took place on June 10th, Senate Finance Committee Chair Ron Wyden (D-Ore.) asked HHS Secretary Xiavier Becerra what tools would be needed to implement a Medicare drug price negotiation plan. Wyden also asked the Secretary if the government should incorporate value assessments into drug price negotiation plans.

The Biden administration has said that it is open to letting drug companies justify drug costs to an independent panel, but Congress has not yet incorporated supporting policy into any of its drug pricing plans. Becerra did not address a value-assessment in his response to Wyden’s question, but emphasized that oversight is important and commented on several of the ideas in the drug pricing bill that Wyden had drafted with former committee Chair Sen. Chuck Grassley (R-Iowa) in 2019, including inflationary drug rebates. (InsideHealthPolicy)

The topic of value assessments has become a key component of the current drug pricing and approvals conversation after the FDA controversially approved the Alzheimer’s drug Aduhelm, which has an annual average cost of $56,000 despite questionable evidence of the treatment’s efficacy. Wyden’s question to Becerra on whether the government should incorporate the assessments followed criticism of the drug’s recent approval, over which several FDA panel experts recently resigned.

More Than 1.2M Enrollees Have Signed Up for Health Coverage Through Healthcare.gov During SEP

Last week, HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure announced that as of last month, more than 1.2 individuals had enrolled in health coverage via healthcare.gov. The number of individuals enrolled during the period does not include the 31 million who are already covered under Affordable Care Act provisions.

In its fourth enrollment snapshot of the special enrollment period (SEP) that began on February 15th this year, the program includes more than 206,000 consumers enrolled in February 2021, 322,000 in March 2021, 469,000 in April 2021, and 376,000 consumers who newly selected a plan in May 2021. Enrollees who were earning less than 400% of the federal poverty level were eligible for a temporary increase in tax credits through the American Rescue Plan, which contributed to the growing numbers of individuals enrolled. (InsideHealthPolicy)

“The importance of keeping health care in reach for every person possible in America is why I fought to protect the Affordable Care Act for three and a half years in federal court.” Becerra said in regards to the snapshot results. On Thursday (June 17) the Supreme Court announced its decision to vote against Texas and other Republican-led states and attorneys general seeking to strike down the ACA over the law’s individual mandate provision. The Justices voted 7-2 to reverse an appeals court decision that had initially claimed the law unconstitutional.

Director Eyeing Efforts to Make Health Equity Measures More Uniform Across CMS

During a webinar hosted by Duke Margolis Center for Health Policy, Center for Medicare and Medicaid Innovation Director Liz Fowler spoke on the need for consistency on how to gauge payers’ health equity efforts. Fowler emphasized that more clear guidance from CMS would assist in creating uniformity across systems so that health care quality can be measured and reported on with the same benchmarks, so as to avoid “muddling the picture” of what quality care looks like.

Fowler explained that CMMI’s Health Care Payment Learning and Action Network (LAN) will be key to helping create a greater sense of urgency around tackling health equity on a national scale. According to the institute, LAN is planning to support pilot efforts to accelerate multi-payer alignment, “particularly around advanced primary care and addressing health equity.” (InsideHealthPolicy)

“If every health plan, provider or payer collects different data or defines race and ethnicity differently I think we risk undermining the credibility of the case that we’re making and the changes that need to happen,” Fowler said during the webinar, which took place on June 10th.

Some health experts believe that the prioritization of health equity should start with Medicaid. Mark Smith of the University of California San Francisco suggested during the webinar that CMMI require an equity lens when considering and evaluating all of its models, similar to required environmental impact reports. The Duke Margolis Center for Health Policy analysis also suggested that states build on CMS guidance and on successful state models to develop a plan and time frame for shifting payments from fee-for-service to value-based pay with accountability for total cost of care and outcomes, “with a clear vision for progress using high-value comprehensive care models to improve key measures of health and health equity in the state.” (InsideHealthPolicy)