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This Week in Health Care Reform - March 20th, 2015

A new analysis maps out what proposed changes to Medicare Advantage could potentially mean for beneficiaries; Republicans release separate budget proposals for 2016; more than 16 million Americans are reported to have gained insurance coverage under the health care law; and, the impact of drug prices continues to reverberate across the health care landscape.


Week in Review

Impact Analysis: As has been covered, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the underlying structure of the popular Medicare Advantage program last month.  If enacted, those cuts would only serve to further unravel the comprehensive blanket of care that nearly 16 million American seniors and persons with disabilities enrolled in the program have come to depend on for their health care needs.  What distinguishes Medicare Advantage from traditional Medicare is its ability to focus care in an integrative and coordinated way, enabling plans to structure care models in a way that caters to some of the most vulnerable patient populations.  Unfortunately, repeated cuts to the program in recent years have resulted in higher out-of-pocket costs and reduced benefits for beneficiaries.  A new state-by-state analysis maps out the potential impact that the latest round of proposed cuts from CMS could have on enrollees.  Prepared by management consulting firm, Oliver Wyman, the analysis breaks down per member per month what the accumulation of cuts from 2013 to 2016 translates into.  As reference, payments to the program from the last two years alone have been cut by nearly 10 percent.  When factored in, these latest cuts could result in higher payments and reduced benefits for beneficiaries of as much as $120 per month on average in some states.  Luckily, stakeholders have risen to the program’s defense.  Most recently, a bipartisan group of 239 members of the House of Representatives sent a letter to CMS, urging the Agency to maintain level funding for Medicare Advantage.  Health Action Network members, like you, have also stood up, sending nearly a thousand messages to lawmakers, asking them to support the efforts to preserve Medicare Advantage.  If you haven’t already, be sure to send your message, too. 

GOP Budgets:
This week, Republicans in both chambers of Congress released their budget proposals for 2016.  With its focus on balancing the budget and laying the foundation for new jobs, the House budget proposal also calls for aggressive entitlement reform, simplification of the tax code, and a full repeal of the Affordable Care Act.  For their part, Senate Republicans proposed less aggressive budget cuts, but would seek to generate its savings from a similar repeal of the health care law, in addition to cutting welfare programs and other federal benefits.  The competing budget proposals now pit fiscal hawks against defense hawks on the road to reconciliation.

16M Covered:
The Administration announced this week that, since the Affordable Care Act’s inception five years ago, more than 16 million Americans have now secured health care coverage.  Further, the report released by the Department of Health & Human Services (HHS) on Monday goes on to show that the uninsured rate dropped from 20.3 percent in 2012-2013 to 13.2 percent.  And, it’s likely those numbers will only continue to improve, especially with new special enrollment periods extended through the federal insurance exchange and in different states.

Rx Prices:
The high (and rising) cost of drugs continues to ravage health care budgets across the country.  Having already spent the past year serving as poster child for this disturbing trend, Sovaldi, Gilead Sciences’ breakthrough hepatitis C drug, doesn’t show any signs of relinquishing its spot atop the cost-driver list, where, despite its efficacy in treating the liver-destroying disease, it’s priced beyond what most states can afford.  However, new classes of drugs are threatening to overtake Sovaldi, in terms of unsustainable pricing.  In its just-released annual Cancer Care in America report, the American Society of Clinical Oncology (ASCO) warns that the cancer care system faces tremendous turbulence owing to a variety of factors, not the least of which being the high cost of cancer treatment, which sees some cancer patients paying an average of $10,000 a month in total cost of care.

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Looking Ahead

With CMS expected to finalize its proposed changes to Medicare Advantage in just over two weeks, there’s still time for Health Action Network members to add their voice to the efforts to preserve the program and protect its millions of beneficiaries. 

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