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This Week in Health Care Reform - January 16th, 2015

In only its second week in session, the House passes its third health care law-related bill; anxiety abounds over the potential disruptive impact of the Supreme Court subsidy decision; states forge ahead on telehealth; drug manufacturers find their outlook increasingly shaped by external forces; and, stakeholders urge Congress to avoid further delays in implementing updated medical coding requirements.


Week in Review

New Year, Same Congress: The start of a new legislative session, much like the beginning of a New Year, can be a time of both promise and optimism.  Where they diverge, however, is in the importance placed upon agenda-setting and the unwavering fidelity to ideological principle.  Case in point – less than a week into the new Congress, lawmakers on Monday passed their third health care law-related measure.  (It’s worth noting that only about half of the new Congress was even around when the law was first passed.)  This latest vote, which seeks to exempt volunteer firefighters from the Affordable Care Act’s employer mandate, follows a pair of bills from last week which sought to extend the same exemption to veterans and to redefine the full-time workweek as 40-hours worked rather than 30.  While some interpret this flurry of health care law-centric activity as nothing more than the New Year offering opponents a fresh opportunity to dismantle the law, others, instead, believe it to be the last chance for Republicans, who now enjoy majorities in both the House and Senate, to offer up their own replacement plan.  Either way, it’s clear that the issue will likely consume a great deal of Congressional bandwidth in 2015. 

Supreme Worry:
With arguments in the case challenging the exchange marketplace subsidies scheduled to go before the Supreme Court on March 4th, opponents, proponents, advocates, stakeholders, observers, and the legally curious, are all anxiously awaiting the outcome.  At issue, whether the Administration is improperly providing tax subsidies to consumers who purchase health coverage through the federal exchange.  As Republicans and Democrats steel themselves for, what’s shaping up to be, a contentious run-up to the hearing, the more pragmatic are already seeking answers to the only question that really matters, namely, who wins if the Supreme Court rules against the federal exchanges?  Certainly not, they offer, the 10 million Americans projected not to enroll in coverage in the 34 states that failed to establish their own exchanges.  At this point, predicting the fallout from the case only results in more questions than answers.  It’s hoped that, at the very least, the ruling will open the door to an ideological compromise on health care reform, maybe even providing Republicans the opportunity to step in and offer fixes of their own.  Regardless, it’s hard to deny that the Supreme Court will not only drive the health care debate in the near term, but could wind up shaping the Administration’s entire remaining agenda.

Telehealth Progress: As telehealth continues to draw supporters from all over the health care spectrum, those standing in its way are beginning to look less like advocates for a cautious approach and more like speed bumps on the road to eventual, widespread adoption.  States, perhaps the greatest laboratory for the telehealth revolution, are blazing their own paths forward, as many seek to adopt new coverage models.  Meanwhile, an actuarial study released late last year highlights the potential for savings in Medicare through the deployment of telehealth services, leading to increased calls to Congress to enact payments in the program for telehealth.  As payers also find themselves exploring the enhancements to health care offered through the application of digital technology to the space, there’s a growing sense of optimism that the telehealth trend will continue its upward trajectory in the year ahead.

Pharmaceutical Landscape:
Now, perhaps more than at any other time in recent memory, the pharmaceutical industry finds itself at a crossroads.  With the spotlight of public scrutiny focused so intently on its processes, pricing mechanisms, and R&D investments, drugmakers are having to operate in a world clamoring for more and more transparency.  As politics and patients look to reshape just how they do business, drug companies now face mounting negotiating pressure from insurers also seeking to rein in out-of-control costs.

ICD-10 Implementation:
The transition from the existing, insufficient set of medical classification codes, known as ICD-9, to an updated model has been anything but smooth.  Concerns over readiness and cost have led to repeated delays.  But, a new study, released late last year, suggests that one of the principal reasons behind the controversial delays may, in fact, have been overstated.  The argument for pushing back implementation has long been one of cost, specifically, those associated with the amount of time and lost productivity that smaller physician offices would have to absorb in order to achieve compliance with the new ICD-10 codes.  However, new data puts forth that those costs are far lower than originally estimated.  With larger organizations, for the most part, ready for the transition, combatting the arguments that have prevented smaller organizations from getting onboard now becomes a little easier.  With stakeholders urging Congress to avoid further delays to ICD-10, questions over timing may now have to step aside for those concerning implementation.

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Looking Ahead

In advance of this year’s tax filing season, some are eager to place at least some of the blame for the anticipated headaches at the feet of the IRS.  And, while there’s reason to be optimistic about how health care costs are trending, experts caution that it’s not all good news. 

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