This Week in Health Care Reform - April 17th, 2015
A final decision is made on changes to Medicare Advantage; state budgets overwhelmed by pricey new drug therapies; the health care law wraps up its inaugural tax season; and, attitudes continue to soften towards telehealth.
Week in Review
Medicare Advantage Decision: After announcing its proposed changes to the popular Medicare Advantage program back in late February, the Centers for Medicare & Medicaid Services (CMS) found itself on the receiving end of a comprehensive and coordinated advocacy effort involving stakeholder voices representing just about every constituency across the health care system. Groups that might not ordinarily find themselves on the same side of many issues came together, throwing their support behind the program, and urging the Agency to preserve Medicare Advantage. Last week, CMS made final its decision, reversing course and increasing payments to plans, rather than carry out its proposed rate cuts. However, it did elect to move forward with its proposed transition to a new Risk Adjustment model that many believe will only do more harm than good. As has been covered in previous newsletters, experts argued that changes to the existing Risk Adjustment model would only undermine plans’ early intervention efforts leaving patients with chronic conditions exposed to even higher costs and lesser care. As the industry works to integrate CMS’ changes into how the Medicare Advantage program is administered, while seeking to insulate beneficiaries from further harm, it bears noting that across the country hundreds of lawmakers from both sides of the aisle stood up to support the program and the millions of American seniors and persons with disabilities enrolled in Medicare Advantage plans. And, Health Action Network members also answered the call, sending thousands of messages to their elected officials urging them to continue their efforts to protect the program and its beneficiaries.
Sovaldi Overwhelms: A new analysis underscores the rising threat to public health represented by the unsustainable trend in drug pricing. Conducted by the Wall Street Journal, their investigation determined that through the third quarter of last year, state Medicaid programs had spent $1.33 billion on hepatitis C therapies – a sum nearly equal to what they’d spent the previous three years combined. Driving that growth was Gilead Sciences’ new $1,000-a-pill breakthrough drug, Sovaldi, which, alone, accounted for 82 percent of all hepatitis C drug spending during that period. And, lest those numbers be dismissed as more exception than rule, a new report from the IMS Institute brings into sharp focus the danger to the health care system posed by specialty drug pricing. According to their research, drug spending jumped to its highest level in more than a decade last year propelled largely by new and increasingly expensive medicines for hepatitis C, cancer, and multiple sclerosis. And, that’s before the other drugs in the pipeline even hit the market: Case in point, Kalydeco, the latest combo drug for cystic fibrosis manufactured by Vertex. According to analysis performed by Prime Therapeutics, the lifetime therapy cost for the drug will total $10.3 million for a patient. It’s hard to argue that our health care system (or any, for that matter) could possibly withstand the crushing burden of such overwhelming prices – a fact that was echoed repeatedly last week in a briefing on Capitol Hill hosted by the Campaign for Sustainable Rx Pricing. Bringing together stakeholder voices from across the health care spectrum, the point was continually hammered home that our system – patients, providers, public programs – was at serious risk of completely unraveling owing to this unsustainable trend in drug pricing.
ACA & Taxes: With the Affordable Care Act’s first tax-filing season in the books, some are a little surprised at how quietly the process played out, at least in the political arena. Given the amount of turbulence caused by the health care law’s individual mandate, many circled this year – when that provision kicked in – as the one that would finally link in consumers’ minds just how far the law reached into their lives. But, with April 15th quickly receding in our rearview mirrors, you’d be hard-pressed to identify any real political uproar over the individual mandate’s having gone into effect. That’s not to say, though, that the occasion went completely ignored. A new poll from Gallup shows that nearly half of all Americans (49 percent) believe that middle-income people pay too much in taxes (up 7 percent from last year). On the flipside, the 42 percent of those polled that said they believe this same group pays their “fair share” is down 11 percent. Perhaps most tellingly, for the first time in nearly a decade, a higher percentage of people belong to the former category than the latter. In any event, that many view their own tax burden as onerous is hard to deny. And, this tax season was made more burdensome by the health care law’s health insurance tax, levied, as its name states, against health insurance, increasing the cost of coverage for families, seniors, and small business owners. The tax is projected to total more than $145 billion over the next ten years. With taxes weighing so heavily on many Americans’ minds, lawmakers have introduced bills in both the House and the Senate aimed at repealing this harmful tax.
Warming to Telehealth: Digital advances continue to improve the way we interact with each other and the world around us. It stands to reason that the application of new technologies would also find traction in the health care delivery space. Already, we’ve seen how technology trends like electronic health records (EHR) and big data are transforming health care. But, patients continue to express a persistent wariness when it comes to fully embracing these new tools. However, beyond the enhancements to access and convenience that telehealth offers all patients, anecdotal evidence is beginning to surface, showing how these advances are also changing the lives of the chronically ill.
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With Congress back in town, here’s a quick look back at the first 100 days from the current legislative session. And, with most Americans having filed their taxes (or extensions) this week, here are some handy infographics depicting how your tax dollars are collected and spent.
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