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This Week in Health Care Reform - February 5th, 2016

Efforts ramp up to protect Medicare Advantage ahead of annual proposed changes to the popular program; a House hearing provides high political theatre on the issue of high-priced drugs; and, the third open enrollment period closes on the exchanges.


Week in Review

Medicare Advantage: Every year around this time, Medicare Advantage stakeholders brace themselves for what’s become an annual rite of passage as the Centers for Medicare & Medicaid Services (CMS) proposes changes to the underlying payment structure for the popular program, currently serving nearly 17 million seniors and persons with disabilities, almost one-third of the entire Medicare population.  In recent years, efforts to protect the program have helped mitigate CMS’ proposed changes, insulating beneficiaries from harm.  However, the aggregated cuts that ultimately get finalized have only left this already vulnerable population increasingly exposed.  With CMS expected to propose next year’s round of cuts later this month, supporters have already rallied, raising their collective voices to draw attention to the critical role that Medicare Advantage plays in the lives of so many, connecting them to the coordinated care that they depend on.  Learn more about how you can add your voice to these ongoing efforts.

Rx Spotlight:
Yesterday, the House Committee on Oversight & Government Reform held a hearing investigating the pressing issue of out-of-control drug pricing.  While the panel of witnesses included experts and representatives from across the industry, one witness managed to monopolize the spotlight by simply appearing.  Martin Shkreli, former chief executive officer of Turing Pharmaceuticals, who found himself thrust center-stage last year when his company, under his stewardship, raised the price of a lifesaving medicine by 5000 percent, took his place alongside the other witnesses.  But, that’s about the only thing they shared in common, as Mr. Shkreli repeatedly invoked his Fifth Amendment right against self-incrimination, declining to answer any questions at the advice of his counsel, before eventually being dismissed from the chamber.  Political theatre notwithstanding, the hearing continues to shine a much-needed spotlight on an issue that’s threatening to swallow our health care system whole.  While the release of last week’s first-of-its-kind collaboration between Eli Lilly and Anthem, which saw the pharmaceutical manufacturer team up with the health insurer on a pair of policy proposals, represents the shared recognition that the solution to this problem affecting us all will ultimately require cooperation from every corner of the health care spectrum, there are storm clouds gathering on the horizon, as it’s expected that as many as seven new “blockbuster” drugs, each with $1 billion-plus in potential annual sales, are expected to hit the market this year.

Open Enrollment Closes:
Late Sunday evening, the third open enrollment period, during which Americans were able to sign up for health coverage on the insurance exchange markets, quietly came to a close.  While there was the expected uptick in activity leading up to the final hours of open enrollment, unlike in the first two open enrollment periods, officials stuck to the deadline.  The previous two years saw the exchanges experience a number of technical glitches, resulting in a less-than-ideal consumer experience, which, in turn, led to open enrollment being extended in both cases.  This year, however, saw relatively little disruption for shoppers on the exchanges.  Final tallies, which were announced yesterday, either exceeded or fell just shy of the most recent predictions (depending on whose numbers you go by), reflecting the growing consensus that there’s still room to improve before the exchanges reach their full potential.

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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.


Looking Ahead

As highlighted, CMS is expected to release its annual proposed changes to Medicare Advantage later this month.  Efforts are already underway to protect the program and the millions of seniors and persons with disabilities who depend on Medicare Advantage for their care needs.  There are currently bipartisan “Dear Colleague” letters being circulated in both the Senate and the House of Representatives, led respectively by Sens. Chuck Schumer (D-New York) and Mike Crapo (R-Idaho) and Reps. Brett Guthrie (R-Kentucky-2nd) and Patrick Murphy (D-Florida-18th), emphasizing the important role that Medicare Advantage plans play in the lives of millions of vulnerable Americans, while also asking CMS to protect the program from further harmful cuts which would have a negative impact on beneficiaries, exposing them to increased costs and fewer benefits.  We encourage our Health Action Network members to reach out to their Members of Congress and ask them to sign their name to the letter. 

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