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• Top News
• Administrative Action
• Congressional Action
• Medicaid
• Litigation
• Research

 

Still Time to Register for Annual Conference

The Roundtable’s highly-regarded annual conference provides our members and guests a unique opportunity to hear presentations by high-level government officials and key experts – from Congress and the Administration, academics, benefit consultants, plan administrators, advocates, and industry leaders in an intimate dialogue-oriented setting. This in-person event will take place in Old Town Alexandria, Virginia on November 9-11, 2022. There’s still time to register for this important annual event!

Click here to Register for the 2022 Conference

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Although we have filled our block of rooms at The Alexandrian Hotel, we’re now working to secure hotel reservations convenient to our conference hotel. For information about alternate accommodations, contact Roundtable Administrator Tom Lussier at Tom@healthcareroundtable.org. 

Top News

CFRB Estimates $200 Billion in Savings From Drug Pricing Reforms

The Committee for a Responsible Federal Budget released a framework for reducing debt and inflation. Their blueprint contains $1.5 trillion in savings from lowering health care costs, including $200 billion in savings from lowering prescription drug costs. The report recommends reforms such as extending Medicare negotiated prices to exchange plans, encouraging generic drug development and reimbursement, and changing how Medicare pays doctors in Part B. Additionally, under the category of reforming benefit design, the report recommends removing the cap on Part D premiums so Medicare can continue to cover a quarter of costs. Earlier this month, President Joe Biden signed an executive order directing the Department of Health and Human Services (HHS) to take additional action to lower the cost of health care and prescription drugs.

 

Report Finds Biosimilars Contributed $21 Billion in Savings Since 2015

Earlier this month, Amgen released its annual Biosimilar Trends Report, which examines the current and future state of the U.S. marketplace with biosimilars. The report also highlights key considerations and learnings from the global marketplace with biosimilars. Data from the report confirmed higher utilization of biosimilars in the last three years and discussed their potential to expand access to treatment options that lower healthcare costs. The report also found that biosimilars covered under the medical benefit have typically launched at a wholesale acquisition cost (WAC) that is approximately 10-57% lower than the reference product. Amgen estimates biosimilars have saved the healthcare system $21 billion since entering the market in 2015.

 

HHS Announces Consumers Can Preview Plans Ahead of Marketplace Open Enrollment

Consumers can preview and compare 2022 health insurance plans and prices on HealthCare.gov ahead of Marketplace Open Enrollment, which begins on November 1. As of October 25, consumers can visit HealthCare.gov to access detailed information about plans offered in their area and find out if they are eligible for financial assistance. According to a press release from the Department of Health and Human Services (HHS), the Biden-Harris Administration has invested nearly $100 million into the Navigators program, which helps enroll eligible consumers and assist them in qualifying for insurance affordability programs. HHS also released a report on Marketplace enrollment, which found enrollments for all racial and ethnic groups has increased from 2020 to 2022. Black and Latino populations experienced a 49% and 53% increase, respectively. The enrollment period will last from November 1 through January 15, giving consumers an additional month to select a plan.

 

OMB Extends Review of Medicare SEPs, Parts of 2021 Appropriations Law

The Office of Management and Budget (OMB) released a final rule to implement parts of the 2021 appropriations law. OMB began reviewing the final rule in August and extended its review of the regulation on October 20. The rule includes policies that allow Medicare beneficiaries’ coverage to begin closer to when they sign up, establish Medicare special enrollment periods (SEPs), extend immunosuppressive drug coverage for kidney transplant recipients beyond the 36-month limit, and update requirements for state payments of Medicare premiums.

Administrative Action

• To address the lack of nursing preceptors, the U.S. Department of Health and Human Services (HHS) is investing $13 million in nursing education and training, with $8.4 million to the Clinical Faculty and Preceptor Academies Program and another $4.75 million to the Registered Nurse Training Program. Currently, the U.S. has a shortage of healthcare professionals that can deliver high-quality, culturally competent care, with nurses, like many other healthcare providers, suffering from burnout. There are also not enough nursing preceptors, or experienced clinicians that can supervise nursing students during their clinical rotations.
  
  
• Earlier this month, the National Association of Insurance Commissioners (NAIC) submitted comments on the proposed 1557 rule which restores and strengthens civil rights protections for patients and consumers in certain federally funded health programs and HHS programs after the 2020 version of the rule limited its scope and power to cover fewer programs and services. NAIC highlighted concerns over how the rule applies to all of a carrier’s operations if they receive federal assistance, including operations in markets where the carrier does not receive federal assistance. The NAIC notes that this interpretation goes beyond the intent of Congress and Section 1557 of the Affordable Care Act. Others report (subscription required) that this could in turn create issues of uneven markets where some carriers abide by certain rules and others do not. America’s Health Insurance Plans (AHIP) echoes this concern in its comment letter. 

Congressional Action

• Last week, a group of women’s health organizations sent a letter (subscription required) to the House Energy & Commerce Committee to ask the committee to mark up a bill authorizing an increase in funding for uterine fibroids research. The organizations signing onto the letter include the Black Women’s Health Imperative, the Society for Women’s Health Research, The American College of Obstetricians and Gynecologists, and others. The Stephanie Tubbs Jones Uterine Fibroid Research and Education Act (H.R. 2007) would authorize $30 million per year for the U.S. Department of Health and Human Services to study uterine fibroids from FY2022 through FY2026.
  
  
• Last Monday, the American Hospital Association (AHA) sent a letter to Congress outlining the organization’s end-of-year priorities as Congress considers its agenda for the closing months of the year. The letter notes that hospitals continue to face financial hardships from the COVID-19 PHE and record-setting inflation impacting staffing and overhead costs. The letter breaks down the requests into two categories, those that address the workforce shortage and those that provide financial relief to hospitals.

Medicaid

• The Kaiser Family Foundation (KFF) released two reports related to Medicaid spending, enrollment, and priorities during the fallout from the COVID-19 pandemic. The first report analyzes state Medicaid enrollment and spending trends for Fiscal Years (FY) 2022 and 2023. The KFF report found a slowdown of enrollment growth during 2022 and projects a decline in 2023. The second report summarizes policy priority results from an annual Medicaid Budget survey for states during fiscal years 2022-2023. Most states are in a strong fiscal position entering FY 2023, but identified uncertainty in their long term fiscal outlook due to economic (wage pressures, inflation, slowing revenue growth) and political (midterm results) factors.
  
  
• Under the Biden-Harris Administration and the American Rescue Plan (ARP), twenty-six states and D.C. have now expanded Medicaid and Children’s Health Insurance Program (CHIP) coverage for twelve months postpartum to cover a total of 418,000 people. Prior to the ARP’s new state plan authority, the minimum postpartum Medicaid and CHIP coverage period was only sixty days. This effort builds on the Administration’s current efforts to address maternal health crisis and the criticality of the postpartum period: one-third of pregnancy-related deaths occur within a year after childbirth. The Biden-Harris Administration has published a Blueprint for Addressing the Maternal Health Crisis while the Centers for Medicare and Medicaid Services have released a Maternity Care Action Plan.

Litigation

The American Hospital Association (AHA), American Medical Association (AMA), and other provider groups submitted two amicus briefs backing the Texas Medical Association (TMA) in another legal dispute over the Surprise Billing Law’s use of qualifying payment amounts (QPAs) in independent dispute resolution processes. The TMA and other providers argue that the arbitration process still favors insurers by preferencing QPAs, giving insurers leverage over physicians in contract and rate negotiations. The AMA and AHA’s amicus brief can be found here, and the amicus brief submitted by the American Association of Neurological Surgeons and a host of other groups can be found here.

Research

• A new budgetary analysis, commissioned by Alzheimer’s Impact Movement (AIM) and conducted by Healthsperien, concludes that the proposed Dementia Care Management (DCM) program could generate nearly $9.2 billion in Medicare and $11.7 billion in federal Medicaid spending over 10 years. The Dementia Care Management program targets patients based on care pathways rather than clinical disease, and theorizes that using evidence based care coordination techniques would reduce adverse health events (including hospitalization and emergency room use) over time. The Alzheimer’s Impact Movement supports legislation that identifies and implements better care for those with dementia, including the Comprehensive Care for Alzheimer’s Act (S. 1125 / H.R. 2517).
  
  
• The 2022 Kaiser Family Foundation Employer Health Benefits Survey reported that nearly half of large employers surveyed had increasing mental health demands from their employees. Although 80% of employers had sufficient primary care providers in their network, only 44% had sufficient behavioral health providers, highlighting behavioral workforce shortages. The survey found that 81% of large firms use third-party mental health services and 44% provide self-care apps. Employers are also concerned about increasing healthcare premium costs, which were similar to last year’s – where employees pay $1,327 for single coverage and employers pay $7,911 – but are expected to rise in response to inflation and higher labor costs.