HealthCare Roundtable e-News – September 17, 2018

Senate Vote on Opioid Crisis Bill Scheduled for Sept. 17

Senators are expected to vote today (Sept. 17) on a bipartisan package of opioid legislation. Senator Mitch McConnell (R-KY) and Senator Lamar Alexander (R-TN) spoke about the package, referred to as the “Opioid Crisis Response Act of 2018,” last week, with Alexander pushing the House and Senate to pass the package, “to the president’s desk as quickly as possible.”

The package includes steps to stop prescription painkillers, like fentanyl and other opioids, from flowing into the U.S. illegally and provide Americans addicted to the drugs with better access to treatment and prevention programs. Fentanyl, one of the most commonly found drugs in opioid overdoses, is a synthetic drug that is 50 times more potent than heroin and often arrives in the United States via mail from Mexico and China. One the bill’s provisions – the Synthetics Trafficking and Overdose Prevention Act, or STOP Act – would close loopholes in existing federal law by requiring the Postal Service to collect electronic data on merchandise entering the country.

Last June, the House passed a wide-ranging opioid bill that included measures for loosening privacy rules for substance abuse records, educating Medicare beneficiaries about pain medication and screening them for opioid use disorder, and encouraging development of non-addictive, or non-opioid pain and addiction therapies.

The Senate will likely vote on the House-passed package, the “SUPPORT for Patients and Communities Act,” with an amendment from Alexander starting around 5:30 p.m. this evening.

Health Groups Sue Trump Administration Over Short-Term Plan Rule Undercutting ACA

Seven healthcare groups sued to block the Trump Administration on Friday (Sept. 14), over expansion of non-Affordable Care Act health insurance plans. The groups are claiming the administration’s short-term limited plan rule undercuts ACA policies and reverses earlier limits on the products, particularly harming people with pre-existing conditions.

The Trump administration argues that the short-term plans are a cheaper alternative to ObamaCare plans, but opponents argue that the short-term plans are not required to cover people with pre-existing conditions and can exclude coverage of certain health services.

The groups claim that the expansion of short-term plans violates the text of the ACA and that plans that last up to one year do not meet any reasonable definition of “short term.” The Obama administration had restricted the initial contract for plans to three months in October 2016, and the groups argued that the Trump administration failed to provide a reasonable explanation for reversing that rule.

Margaret Murray, CEO of The Association for Community Affiliated Plans (ACAP), suggested that short-term plans, “are like the small spare tire in a car: they get the job done for short periods of time, but they have severe limitations and lead to trouble if you drive them too fast or too long. Consumers who substitute comprehensive coverage with a STLDI plan will be rudely reintroduced to denials of care on the basis of pre-existing conditions, coverage limits and fine print should they need care in a meaningful way.”

National Alliance on Mental Illness (NAMI) CEO Mary Giliberti, among the organizations filing the suit, suggested the rule “rolls back the clock on Congress’ bipartisan efforts to ensure patient protections and fair insurance coverage of mental illness.” ACAP and NAMI were joined by Mental Health America, the American Psychiatric Association (APA), AIDS United, National Partnership for Women & Families, and Little Lobbyist in filing the suit.

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Casey, Thune Urge CMS to Expand Access to Evidence-Based Opioid Treatment to Seniors

In a letter to the Centers for Medicare & Medicaid Services, U.S. Senator Bob Casey (D-PA), Ranking Member of the U.S. Senate Special Committee on Aging, Senator John Thune (R-SD), and a bipartisan group of senators urged the expansion of the Medicare Advantage Value-Based Insurance Design (MA VBID) model to increase access to evidence-based opioid treatments among senior citizens and people with disabilities.

The letter to CMS Administrator Seema Verma emphasized that one in three people, based on 2017 research by U.S. Department of Health and Human Services Office of Inspector General, with Medicare Part D received an opioid prescription, heightening risk of opioid misuses or overdose to an estimated 71,000 people with Medicare. The senators wrote, “As you endeavor to use every tool available to ensure that not one more life is lost to opioids, we urge you to draw on value-based insurance design concepts that promote access to high-value, evidence-based health care.”

CMS had launched MA VBID back in 2017 as a test model to improve access to prescription drugs among Medicare enrollees living with chronic conditions. Congress had recently opted to expand these practices, making MA VBID accessible nationwide through the bipartisan CHRONIC Care Act.

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Lawmakers Secure Labor-HHS Deal Avoiding ACA Cuts

Late Thursday (Sept. 13), House and Senate negotiators reached a spending deal that includes $90.3 billion in discretionary program funds for HHS, of which $4 billion will be designated for mental health and opioid treatment.

In a summary of the conference agreement, Senate Appropriations Committee Vice Chairman Patrick Leahy (D-VT) claimed, “This agreement invests in the American people and ensures that the government remains open into December. Just as importantly, Congress, Republicans and Democrats, rejected President Trump’s draconian budget cuts, which would have slashed programs in the Labor, Health and Human Services, Education and Related Agencies bill by $10.7 billion.”

The bill omits a $472 million cut to CMS, which was originally proposed by the House and would have restricted HHS’ ability to enforce the Affordable Care Act. Senator Leahy confirmed the bill would provide CMS with funding that is consistent with the 2018 fiscal year, protecting its ability to administer Medicare, Medicaid and the ACA

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