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This Week in Health Care Reform: January 19th, 2018

Stakeholders prepare themselves for the annual push to protect Medicare Advantage and its beneficiaries; drug profits soar as prices rise; and, value-based care finds a strong proponent in the new HHS nominee.

Week in Review

(Lawmakers continue in their efforts to work out a stopgap funding bill to keep the government running ahead of tonight’s midnight deadline.  With developments unfolding too late for inclusion in this week’s newsletter, be sure to keep up with the latest on the Health Action Network’s Facebook page and Twitter feed.)

Medicare Advantage: Every year around this time, the Centers for Medicare & Medicaid Services (CMS) proposes changes to the underlying payment structure for Medicare Advantage.  Cuts enacted on the program in recent years by CMS have threatened to undermine access to the preventive and coordinated care that has been proven to make a difference in the quality of care upon which millions of vulnerable beneficiaries depend.  With CMS’ latest proposed changes already beginning to surface, stakeholders are marshaling in support of the program.  Learn more about what makes Medicare Advantage so valuable and be sure to keep an eye out to see how you can help.

Rx Profits:
A recent report from the Government Accountability Office (GAO) details just how explosively prescription drug prices have risen over the past three decades.  According to the GAO analysis, the amount of money people spend on their medicines has nearly doubled since the 1990s.  Back then, retail prescription drug expenses accounted for about 7 percent of total health care spending in the US – by 2015, that number had ballooned to nearly 12 percent.  In fact, between 2006 and 2015 about two-thirds of drug companies saw their profit margins increase more than 17 percent on average.  Experts were quick to point out that the report only serves to reinforce the established narrative that drug prices are out of control and that drugmakers will only continue to raise prices in excess of inflation absent regulation and the kind of transparency that increases consumer awareness.  As these costs ultimately get passed onto the government, insurers, patients, and taxpayers, lawmakers have explored the possibility of attaching a measure aimed at combatting the issue to their impending spending deal.  Known as the Creating and Restoring Equal Access to Equivalent Samples Act, the proposed piece of legislation would prevent branded pharmaceutical manufacturers from employing tactics to delay competition from less expensive generic drugs.

Value-Based Care:
Earlier this week, Alex Azar’s nomination to head up the Department of Health & Human Services (HHS) advanced out of the Senate Finance Committee.  (A confirmation vote before the full Senate has yet to be scheduled.)  During last week’s confirmation hearing, the HHS nominee indicated his full support of the transition to value-based care already reshaping the topography of the health care landscape, saying it was time to “shift the focus in our health care system from paying for procedures and sickness to paying for health and outcomes."      

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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.



Medicaid seems to be finding itself the topic of increasing discussion.  Irrespective of the politics surrounding the program – which currently serves more than 70 million adults, children, moms and their newborns, seniors, and persons with disabilities – the vast majority of Americans support a strong, sustainable Medicaid program.  And, not only has Medicaid proven itself to be effective, providing its beneficiaries with access to quality care and benefits – including critical mental and behavioral health support, it’s also been an economic boon for states that chose to expand their programs.

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