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This Week in Health Care Reform - November 7th, 2014

An unsatisfied electorate heads to the polls, leaving the country to wake up to a radically altered political landscape; backend issues on the federal government’s health exchange website persist; the debate continues as to whether or not high drug prices lead to innovation; and, Medicare ups its investment in telehealth.


Week in Review

Midterm Wave: Regardless of your political persuasion, you’d be hard-pressed to categorize the results from this Tuesday’s midterm elections as anything but a wave.  Whether a commentary on the general mood of the electorate or a direct repudiation of the Administration and its policies, Americans went to the polling booth this week with change on their minds.  By the time the dust settled, Republicans had not only secured enough seats to recapture the majority in the Senate, but they’d also managed to increase their numbers in the House to levels unseen in almost a century.  As political analysts turned their attention to how, exactly, the GOP GOTV machine managed to pull off such a resounding result, and the effect that voter turnout had on the final outcome, policy experts, instead, focused on what impact the midterms could have on the issues.  Heading into Tuesday’s election, it was clear that the outcome would have far-reaching implications on health care policy.  And, on this side of Election Day, we now have a clearer picture of Republican’s plan-of-attack towards the health care law.  But, many caution GOP leadership, reminding them that this kind of mandate, unequivocally, carries with it, bigger expectations.  As pressure builds for Republicans to coalesce around a bold agenda, House Speaker, John Boehner (Ohio), and presumptive, new Senate Majority Leader, Mitch McConnell (Kentucky) took to the press, mapping out their vision for what they hope to get done now that their party has control of both chambers of Congress.  And, none too soon, it would seem, as conversations are already burbling ahead of 2016, when not only the White House will be up for grabs, but Republicans will be forced to defend 24 of the 34 contested Senate seats in order to keep their majority. 

Exchange Issues:
With the second open enrollment period set to begin next week, there’s growing anxiety over technological issues that continue to plague the backend of  Last year’s bumpy rollout of the government’s health insurance exchange website left consumers frustrated and confused and resulted in billions of dollars worth of enhancements and fixes being applied to the troubled online portal.  As millions of Americans are expected to flood to the site once enrollment opens on November 15th to purchase or change their coverage, industry experts are cautioning that there may still be some bumps in the road.  And, despite the litany of improvements to the website’s infrastructure, even federal officials are quietly acknowledging the likelihood that not all the kinks will have been worked out.

Price of Innovation: A good deal of coverage has been devoted to the rising price of specialty drugs and the effect that those costs are having on our health care system.  Already, we’ve seen how drugs like Gilead Sciences’ $1,000-a-pill Sovaldi are ravaging state budgets and federal programs, leading to some very difficult treatment decisions, including limiting the drug to only those patients in advanced stages of hepatitis C.  Beyond Sovaldi, though, the trend in specialty drug pricing threatens to, not only collapse budgets and render ineffective vital social safety net programs, it has the potential to completely overwhelm our health care system.  While the argument coming from the pharmaceutical industry continues to be one of pricing to adequately foster innovation, there’s growing dissent over whether or not high drug pricing does, in fact, accomplish this, or hurt it.

Telehealth Investment: As digital advances usher in a transformational change to our health care system, telehealth continues to figure prominently in how, when, and where we will access our care in the near future.  Regulatory barriers notwithstanding, as consumers, we have also become more digital and our expectations along those lines increasingly drive our choices.  Given the limitless possibilities offered by these technological advances, it stands to reason that the digital ecosystem would spread beyond traditional borders and find ways to apply itself across every industry.  Insurers, for their part, have recognized this, seeking to enfold digital into their mechanics.  And, it would appear that the federal government has also taken notice, announcing over the weekend that the Centers for Medicare & Medicaid Services (CMS) will be increasing its payments to sites offering telehealth services next year.  The agency even went so far as to list seven new procedure codes for telehealth services in its 2015 Medicare physician fee schedule.

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Looking Ahead

On the eve of the next open enrollment period launching, some believe it’s worth asking, is the Affordable Care Act working as intended? 

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