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HEALTH ACTION NETWORK - ADVOCATES FOR BETTER HEALTH CARE SOLUTIONS

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This Week in Health Care Reform - November 14th, 2014

With open enrollment set to begin, officials are working feverishly to avoid last year’s mistakes; the Supreme Court announces its decision to hear the case challenging the Affordable Care Act’s subsidies; drug costs continue to darken the health care cost horizon; and, now that the midterm dust has settled, what can we expect from the next Congress?

 

Week in Review

Enrollment Anxiety: By this time last year, Americans had spent the better part of six weeks trying out the federal government’s health insurance exchange website, HealthCare.gov, and the collective experience left a lot to be desired.  Between the high-volume of users routinely crashing the site and the general lack of understanding concerning the law’s intricacies, the consumer experience was wanting.  Fast-forward a year and there’s lingering concern – even with officials scrambling ahead of tomorrow’s launch of the second open enrollment period – that the hard-learned lessons from a year ago, will continue to exact a toll on this year’s rollout.  Despite upgrades to the website’s cybersecurity, and assertions to the portal’s safety, Administration officials acknowledge that, while improvements have been made, consumers shouldn’t expect the new HealthCare.gov to be perfect.  In light of these ongoing challenges, last weekend, officials opened up the website to allow people to begin window-shopping on the site.  Still, behind-the-scenes, contingency planning is already underway to avoid a repeat of last year’s botched rollout.  And for their part, insurers have also begun ramping up their support infrastructure in preparation for the next wave of sign-ups. 

SCOTUS: Legal observers were kept waiting until the end of last week before the Supreme Court finally announced its decision to consider the case challenging the insurance subsidies being extended to consumers via the federal health exchange.  The announcement, which came last Friday, now sets the health care law on a return trip to the Supreme Court.  Given the ramifications of the outcome, there’s more than a little anxiety surrounding the case as it makes its way back to the highest court in the land.  In the meantime, a separate challenge currently before a lower federal appeals court was pulled from that court’s docket due to the case covering similar legal ground.

Orphan Drugs:
As has been widely reported, the runaway cost of new breakthrough drugs for hepatitis C is threatening to blow a hole in the health care system.  Given the millions of Americans estimated to have the liver-damaging disease, it’s not hard to imagine what the aggregate cost of treating those patients with these expensive new therapies might look like.  A new model, developed by MD Anderson researchers, took a look at the existing data (e.g., population size, cost of therapies, treatment guidelines) and was able to calculate that the total cost of treating just 1.6 million hepatitis C infected patients could be as much as $188 billion over a five-year period.  Alarmingly, this trend has already begun to extend beyond this disease and is exerting pressure on entire classes of drugs (like oncology), leading some to warn that drug costs are on track to bankrupt the entire American health care system.  To drive that point home, a new report estimates that orphan drug sales, alone, will make up 19 percent of total prescription drug sales by 2020, an annual growth rate of nearly 11 percent, compared to that of non-orphan drugs, which is roughly 4 percent.  Orphan drugs are typically cheaper to develop, have smaller patient populations, and lack alternative treatment options, giving them an edge in the regulatory review process.  On average, the cost-per-patient for orphan drugs is six times that of non-orphan drugs.

Midterm Fallout:
Post-election analysis aside, the fallout from the midterms continues to reshape Washington’s landscape.  While many wonder what having Republicans at the helm in both the House and the Senate may mean for the White House and the legislative agenda in general, others are more concerned with the GOP’s immediate plans for the Affordable Care Act.  While some busy themselves considering how the results from this month’s midterms portend a host of changes for the health care law, others have already moved on, turning their attention, instead, to 2016’s elections.

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We encourage you to stay involved as implementation efforts surrounding health care reform progress.  Visit the Health Action Network and be sure to let us know what's on your mind.


 

Looking Ahead

The administration lowers its 2015 enrollment projections (not to mention, 2014’s running tally).  Meanwhile, lawmakers return to Washington with a lame duck to-do list.  And, with so much uncertainty swirling around the health care law – from a GOP-controlled Congress  to the disruptive potential of the latest Supreme Court challenge – what does the future hold for the Affordable Care Act? 


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