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This Week in Health Care Reform - January 9th, 2015

Enrollment in the exchanges continues apace; anxiety builds amongst the Medicare Advantage community ahead of next month’s annual release of proposed changes to the program’s underlying payment structure; specialty drugs’ ominous shadow grows over the health care landscape; the telehealth market is poised to boom; and, the impending tax season promises to be a complicated one.


Week in Review

Exchange Enrollment: As of last week, nearly 6.6 million Americans had enrolled in health coverage on the federal government’s website.  While early indications suggest that signups during this year’s open enrollment period could exceed the Administration’s target of 9.1 million enrollees by the end of 2015, some are quick to point out that that projection is relatively modest compared to the Congressional Budget Office’s (CBO) original estimate of 13 million.  Still, based on early returns, some experts project upwards of 10.5 million enrollees by the end of the year.  However the numbers ultimately shake out, to many, the conversation has now shifted from focusing on why the health care law won’t work to asking whether or not it already is. 

MA Worries:
Every year around this time, Medicare Advantage finds itself in the crosshairs.  The popular program, serving nearly 16 million Medicare beneficiaries, annually gets marched before the Centers for Medicare & Medicaid Services (CMS), which then releases its proposed changes to how the program gets funded.  In years past, those changes have resulted in not only reduced benefits for the millions of seniors and persons with disabilities that depend on Medicare Advantage, but higher costs for this vulnerable population, as well.  Despite studies highlighting the program’s efficacy compared to traditional Medicare fee-for-service (not to mention analyses drawing attention to the migration of beneficiaries from the latter to the former), CMS’s annual proposed changes to Medicare Advantage have only served to compress its underlying payment structure.  But, there’s hope.  Ahead of this year’s battle to protect Medicare Advantage, a growing chorus of voices has kept a spotlight on the issue, talking up the program’s value proposition and how it’s working to better the lives of millions of Americans.  Keep up with the latest developments and add your voice to the fight by joining the Coalition for Medicare Choices.

Specialty Drug Costs: Recent deals by Express Scripts and CVS with hepatitis C drugmaker rivals AbbVie and Gilead Sciences, respectively, represent something of a seismic shift in the health care landscape.  While it remains to be seen what impact exactly these exclusive agreements may ultimately have on the industry, it’s clear that the deals negotiated by these two companies, which, combined, represent as much as 63% of the country’s total pharmacy benefits management market, chart a new way forward as stakeholders scramble to insulate themselves and their constituencies from pharmaceutical manufacturers’ capricious pricing strategies that have come to dominate the health care cost debate.  And, with so many more high-priced drugs expected to hit the market, it’s a strategy that may find necessary traction.

Telehealth Growth:
The telehealth market is projected to nearly double over the next five years.  Given the growing body of evidence drawing attention to the potential savings, connectivity, and efficacy achieved through its increased utilization, it’s not hard to see why investors are flooding the market.  With lawmakers having returned to the business of legislating, there’s growing hope that the issue has drawn enough support to find its way onto their agenda.

Taxes & the ACA:
This year, for the first time, Americans will have to address their health insurance status when they file their taxes.  While the majority will only have to check a box indicating that they had coverage in 2014, for the remaining taxpayers, who either received subsidized coverage through the exchanges or decided not to enroll for insurance at all, the process will be slightly more complicated.  Add to that, the warning from IRS officials that budget cuts and staff reductions will result in fewer customer service representatives being available to answer questions, and it’s not hard to imagine why many may be approaching this year’s tax season with more than a little trepidation.

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Looking Ahead

As we take our first steps into the New Year, here’s a quick look back at some of 2014’s most important health care stories, numbers, and charts; some of last year’s biggest successes and failures; and, who some of the winners and losers were.  Also, with the new Congress locked-and-loaded, a review of what the lame duck may (or may not) have told us about what we can expect from the next legislative session. 

You can keep up with the latest by following the Health Action Network on Twitter and by liking us on Facebook.