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This Week in Health Care Reform - October 17th, 2014

What consumers can expect as they flock back to the exchange once the next enrollment period opens; Gilead turns a deaf ear to the hue and cry for reasonableness in its pricing decision for its next generation hepatitis C drug; telehealth continues to make inroads across the country; and, small business owners raise the alarm over the health care law’s health insurance fee.


Week in Review

Round 2: Next month, the second open enrollment period will begin on the health insurance exchange marketplace.  For the millions that didn’t sign up last year, or for those enrollees simply looking to renew or change their policies this year, that means one thing: A return trip to  It’s no secret that last year’s launch of the insurance exchange portal left much to be desired.  Technical glitches on both the front- and back-end resulted in a less than ideal user experience.  But, more than a year, and a couple of billion dollars, later, officials promise a revamped and, hopefully, improved experience for consumers.  While the Centers for Medicare & Medicaid Services (CMS) have said that people who are already enrolled will be automatically re-enrolled, health policy experts and consumer advocates recommend that folks take a more active role in their insurance decisions – advice, it would seem, that two-thirds of those already insured via the exchange have every intention of heeding.   

Harvoni Pricing: As expected, last week, the FDA announced it had approved Gilead Sciences’ next generation hepatitis C drug, Harvoni.  And, also as expected, Gilead wasted no time in announcing how the first, all-oral, combo medication would be priced.  Clocking in at $94,500 for a typical 12-week course of treatment, Gilead’s new drug will run patients $1,125-a-pill.  In defending their decision to price the drug higher than its predecessor, Sovaldi, which came in at $1,000-a-pill, Gilead offered that about 40 percent of patients may be able to finish their course of treatment in 8-weeks, reducing the price to around $63,000.  Response from stakeholders across the health care spectrum was swift.  Given the turbulence that Sovaldi has already injected into budgets all over the country, many had pinned their hopes on the drug’s manufacturer pricing Harvoni in a way that would reverse, or at least, stabilize, the trend in specialty drug pricing currently wreaking havoc in the health care system.  Unfortunately, Gilead’s decision to, in fact, raise the price of its new drug only seems to reinforce the disturbing commitment to an unsustainable price and cost trajectory that many see the pharmaceutical industry intent on leading the country down. 

Telehealth Momentum:
As technology and its various applications in the delivery of health care services find a growing, receptive audience in the health care space, the power of connectivity promises to usher in a paradigmatic shift in just how and where and when patients access their care needs.  Long thought to be the domain of the digital dreamer, that the telehealth market is projected to hit more than $43 billion by the end of the decade is testament to how integral investors, stakeholders, and practitioners now view technology to the practice of medicine.  And, beyond the private sector, public health services have also started to embrace telehealth as a way of improving care delivery, such as the Department of Veterans Affairs (VA), which, it just announced, was on track to conduct more than 2 million telehealth visits this year.  As the infrastructure and architecture supporting the digital ecosystem continues to improve, so, too, will telehealth, which, it would seem, is finding its way.

Fee Angst:
The second open enrollment period affords us the opportunity to take a look back at our changed (and changing) health care landscape.  While some still bristle at any mention of the health care law, it’s become increasingly harder to deny that the world as we know it has evolved.  Unfortunately, one way in which it’s no longer the same is also having a deleterious effect on a constituency that’s vital to the economic health of our country.  The new health insurer fee, levied against insurers based on their book of business, is hitting small business owners particularly hard.  The fee is expected to total around $8 billion this year, alone, resulting in an increase in the cost of coverage for this group.  In fact, the National Federation of Independent Business Research Foundation estimates that the ripple effect of the health insurer fee will lead to as many as 239,000 jobs lost by 2023, while GDP could be as much as $33 billion less than it would be were it not for the fee.  For their part, small business owners across the country have begun to raise their voices in opposition to this harmful new fee, which seems to undermine the stated goal of the law, which would be to enhance affordability across our health care system.

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Looking Ahead

The health care law gets pushed aside on the campaign trail as signs point to the GOP holding an election advantage with the midterms less than three weeks away.  Meanwhile, experts begin to outline possible results scenarios, including a ‘to-do’ list for a Republican-controlled Congress. 

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