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This Week in Health Care Reform - March 28th, 2014

A multitude of voices continue to rise up in defense of Medicare Advantage, as the fight against proposed changes to the program enters the home stretch; meanwhile, an extension is offered up, just days ahead of enrollment closing; the health care law celebrates its 4th anniversary; and, a costly new drug draws attention for all the wrong reasons.


Health Care Reform

Raising the Alarm over Medicare Advantage Cuts: As has been covered here, the fight to protect Medicare Advantage – and the 15 million seniors and persons with disabilities that depend on the program’s model of coordinated care – from further harmful payment cuts has drawn a laundry list of supporters to its cause.  Experts project that those cuts, proposed by the Centers for Medicare & Medicaid Services (CMS) last month, would result in a 5.9 percent cut to Medicare Advantage payments next year, which, in turn, could lead to a tremendous amount of disruption in a market that caters to an already vulnerable population.  When combined with the cuts already enacted upon the program by the Affordable Care Act (ACA) – in addition to the payment changes imposed on Medicare Advantage by CMS last year – the new proposed cuts could not only leave beneficiaries having to face a reduction in benefits and higher out-of-pocket costs, but with fewer choices, as plans are forced to leave the market.  Luckily, enrollees have a large and growing network of supporters in their corner.  The following list, while not comprehensive, offers a sampling of the groups that have already voiced their concerns over the harm posed by CMS’ latest round of payment cuts:

Experts: Partnership for the Future of Medicare (PFM); Healthcare Leadership Council (HLC)

Providers: California Association of Physician Groups (CAPG); National Hispanic Medical Association (NHMA); American Medical Group Association (AMGA); Care Continuum Alliance (CCA); Medicare Advantage Action CoalitionSNP Alliance

Interest Groups: National Caucus & Center on Black Aged (NCBA)

Employer Groups: U.S. Chamber of Commerce; National Association of Manufacturers (NAM); American Benefits Council (ABC)

Meanwhile, seniors have also taken up the mantle, letting decision-makers know, in their own words, what Medicare Advantage means to them.  From Arkansas to New YorkLouisiana to Wisconsin, and North Carolina to Texas, beneficiaries have been sharing their stories.  Finally, lawmakers have heard their constituents loud-and-clear.  To date, more than 250 members of Congress have signed letters of support for Medicare Advantage, urging CMS to maintain level funding for the popular program in 2015.  See if your lawmaker was one of them (here and here) and be sure to let them know you appreciate their standing up to protect Medicare Advantage and the millions that depend on the program by sending them a letter.  And, keep up with all that’s happening in the fight to preserve Medicare Advantage by visiting the Coalition for Medicare Choices

Limited Extension Granted: Despite repeated assertions to the contrary, as expected, the Administration announced late Tuesday evening that it was, in fact, extending the open enrollment period for people to purchase coverage through the insurance exchange marketplaces…at least, sort of.  With less than a week before the enrollment period was set to close, polls depicted an American public, particularly the uninsured, persisting in its general state of unawareness regarding the health care law’s specifics, including the March 31st deadline by which Americans were to have secured coverage, lest they feel the sting of the individual mandate’s penalty next year.  While specifics of the extension were still unclear, what is known is that consumers who say that they started the process of buying coverage through the web portal ahead of Monday’s deadline but could not finish, would now have until the middle of April to seek an extension.  The White House defended its decision to grant the extension on Wednesday, likening the accommodation to voters being allowed to cast their ballots as long as they’re in line before the polls close.  Critics, however, aren’t buying it and point to the extension as merely the latest in a long string of delays and last-second changes to the health care law’s rollout handed down by the Administration.  For their part, industry experts are beginning to wonder how much more strain the relationship shared between insurers and the Administration can take.  On the bright side, officials announced yesterday that more than 6 million people have now signed up for coverage through the federal and state exchanges.

Happy Birthday, ACA: This past Sunday marked the 4th anniversary of the health care law.  While your political persuasion probably had a lot to do with how you marked the occasion, four years after the ACA was signed into law, new polling shows that it remains as unpopular as ever.  The survey, conducted by the Pew Research Center, found that 53 percent of respondents disapproved of the law, compared to the 41 percent that approved of it.  However, of those that voiced their disapproval, 30 percent said that they wanted elected officials to try to make the law work, as opposed to the 19 percent that wanted them to try to make it fail, a continuing trend, researchers noted, and a stark contrast to how evenly divided this same group was in polling conducted prior to the launch of the exchanges.  Regardless, while some chose to commemorate the occasion by taking a look back at the law’s formative stages, a new study shed some light on what the road ahead might look like.  That analysis, released by the conservative American Action Forum, found that the costs of complying with the ACA ($6.8 billion annually) have, to date, outweighed the benefits ($2.6 billion annually) – a trend that, the study’s authors go on to say, will likely continue absent significant reforms.  Meanwhile, a separate survey, conducted by The Morning Consult, seemed to reinforce that theme, with 60 percent of respondents saying they believed the health care law would increase their costs in the long run, versus the 11 percent who said they felt the opposite.

Sovaldi in the Spotlight: A new drug designed to cure hepatitis C finds itself at the center of a growing industry and political firestorm.  That drug, Sovaldi, has been hailed as a breakthrough in the fight against the blood-borne disease that currently affects as much as 2 percent of the adult population of the country or 3.2 million Americans.  However, the manufacturer, Gilead Sciences, priced Sovaldi at $1,000-a-pill, or $84,000 for a 12-week course of treatment.  While some are concerned with the larger issue at-stake here (namely, the escalating cost of specialty drugs), others are demanding a more immediate reckoning from the drug’s manufacturer, specifically, Gilead’s CEO, who some analysts project to profit considerably from Sovaldi.  Already, the price of the drug has drawn heavy criticism from both advocacy groups and insurers.  Lawmakers have also taken note and are now pressing Gilead to explain the hefty price tag.      

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Looking Ahead

CMS is expected to make its final determination regarding the proposed payment cuts to Medicare Advantage on April 7th.  Until then, there’s still time to make sure your voice is heard.  And, with open enrollment scheduled to (kind of) close on Monday, here’s a breakdown of 17 qualifying events under which consumers can apply for an extension.

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