This Week in Health Care Reform - April 4th, 2014
The Medicare Advantage community anxiously awaits CMS’ final payment decision, expected on the other side of the weekend; open enrollment goes out the way it came in – shakily, while attention shifts to where the law (generally) and premiums (specifically) go from here; and, Gilead finds itself on the defensive over its latest drug.
Health Care Reform
Medicare Advantage Decision Looming: This coming Monday brings to an end what to date has been a massive, albeit cohesive, mobilization of support for the popular Medicare Advantage program. As has been exhaustively covered here, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the underlying payment structure of the program in February that expert analysis estimates to be a 5.9 percent payment cut going into next year. What that means to the more than 1-in-4 Medicare beneficiaries enrolled in a Medicare Advantage plan is the potential for further reduced benefits, higher out-of-pocket costs, and fewer choices, as this population prepares to integrate these proposed cuts on top of those already imposed upon the program by the Affordable Care Act. But, ahead of CMS announcing its final decision this coming Monday, Medicare Advantage supporters have been rallying to its defense, urging the agency to protect the program and its 15 million beneficiaries from further, damaging cuts. Even lawmakers have taken up the cause – and, in a decidedly bipartisan way; all the more meaningful with political common ground so hard to come by. (And, the political ramifications of the proposed cuts have not gone unnoticed, just seven months away from Election Day.) Even as debate rages over what’s really at stake here, the ones with the most to lose – the seniors and persons with disabilities who depend on Medicare Advantage every day for its proven model of coordinated care – have overwhelmingly voiced their opposition to the proposed cuts.
Open Enrollment Ends: This past week saw the close of open enrollment on the insurance exchange marketplace (well, at least for those folks not already ‘in line’). As midnight approached this past Monday, volume surged at federal call centers and at the online portal, HealthCare.gov. Perhaps unsurprisingly, enrollment on the exchange ended pretty much how it began, hamstrung by technical glitches. However, once the smoke cleared, the Administration was able to announce that it had actually exceeded expectations, surpassing its original self-imposed target of 7 million enrollees. Still, despite the White House’s eagerness in touting the final tally as an indication of the law’s success, others weren’t quite as ready to declare the tide as having turned. Some still wonder what success even looks like, leveraging the argument that the Affordable Care Act leaves unanswered the central issue of actually addressing costs. Regardless, it’s hard to deny that the exchange marketplace eventually found its way to more solid footing, far from a sure thing given the numerous hiccups that plagued the early days of the rollout. As the conversation now turns to just how many of those enrollees have, in fact, paid their premiums, there’s growing consensus that the law’s conceptual proof has yet to translate into a practical one.
ACA's Political Influence: Given that we find ourselves in the early stages of a midterm election year, it’s hardly surprising that the messaging machines on both sides of the aisle are already humming. Whether or not you share the pervasive status quo attitude Americans seem unwilling to relinquish towards Washington, it’s hard to argue that health care – specifically, the Affordable Care Act – figures to be an important talking point on the campaign trail this fall. Even as new polling finds the sweeping health care law enjoying its highest level of support to date (49 percent), not everyone is rushing forward to lock arms with it. Despite holding a slight edge over their Republican counterparts in a generic ballot, experts believe that Democrats could be in for quite a fight come November, particularly in the Senate (which probably explains what compelled a handful of them to offer up their own vision of how to fix health care reform). Republicans, meanwhile, don’t seem to be suffering any such crisis of messaging and are continuing to hammer away at the law. One thing both sides do seem to agree on, though, is the belief that a good deal of the angst surrounding the issue is being driven largely by the media. Nevertheless, as Democrats and Republicans redraw their health care reform battle lines, it’s abundantly clear that the politics of reform will go a long way in shaping the electoral outcome.
Premiums Likely to Rise: Having demonstrated its ability to attract consumers by the millions, rumblings have begun to surface concerning the practical realities of what those consumers’ premiums could look like next year under the Affordable Care Act. Already, stakeholders are cautioning the American public that the real work is only now beginning. Meanwhile, insurance industry officials and independent analysts have also started warning that the combination of a lack of hard enrollment data and the rampant uncertainty that continues to march in lockstep with the law’s implementation will likely result in huge variations in premiums, with many expected to hit double-digits.
Sovaldi Defense: As covered last week, Gilead Sciences continues to find itself under fire for pricing its breakthrough hepatitis C drug, Sovaldi, at $1,000-a-pill. Given the medication’s 12-week regimen, that comes out to $84,000 for a single course of treatment. With lawmakers breathing down their neck, the manufacturer’s non-responsive response has been to point out that Gilead has discount agreements in place with a number of health insurance companies, prompting one insurer to label the costs of Sovaldi as “outrageous.”
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