This Week in Health Care Reform - May 20th, 2016
A pair of legal challenges muddies the waters surrounding the health care law; a new study puts a pricetag on just how much more we’re spending on brand-name drugs; and, despite telehealth’s promise, a disconnect persists.
Week in Review
Lawsuits: Late last week, a federal judge ruled in favor of House Republicans, whose latest lawsuit brought against the Affordable Care Act (ACA) challenges that the Administration is illegally making “cost sharing reductions” available to consumers absent the Constitutionally-mandated Congressional appropriation. In handing down her ruling, U.S. District Court Judge Rosemary Collyer wrote that Congress, despite having authorized the program, never actually provided money for it. At stake, the cost-sharing subsidies that benefit millions of low-income Americans. While not necessarily a death blow to the future of the health care law, it would push costs higher for those who can least afford it. Important to note, though, that the ruling was stayed, pending an appeal by the Administration. In a separate ruling handed down on Monday, the Supreme Court sent back down to the lower courts several challenges to the ACA’s contraceptive-coverage requirement brought against the law by religiously-affiliated organizations. However, in rendering their opinion, the Court went out of its way to make clear that it was not deciding the merits of the case, rather, providing an opportunity for the parties to “arrive at an approach going forward that accommodates petitioners’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans receive full and equal health coverage, including contraceptive coverage”. The carefully balanced decision is reflective of the cautious approach of the Court, which now finds itself equally divided along ideological lines since the death of Justice Antonin Scalia in February.
Rx Spending: Despite the increased focus on finding cost-savings in the prescription drug space, a new study discovered that Americans spent $73 billion more on brand-name drugs between 2010 and 2012, despite the availability of lower-cost alternatives. What’s more, consumers paid nearly one-third of those additional costs themselves, out-of-pocket. The study was published in JAMA Internal Medicine this month and points to the need to improve efficiencies at the point of prescribing, including the increased use of generic drugs and, when those are unavailable, therapeutic substitutes, both as a mechanism through which to combat rising drug costs.
Measured Promise: The convergence underway between health care and technology continues to reshape how and when and where we interact with our health care system. Not only does telehealth facilitate this paradigmatic change by increasing access, improving the care experience, and streamlining efficiencies, but, it also advances the shift to more value-based reimbursement models. Stakeholders, too, have done their part in helping to usher in this new era by removing some of the barriers that have traditionally kept consumers from embracing telehealth. However, as with any fundamental change, that embrace has been neither complete nor swift. A new report speaks to the challenges stalling telehealth’s wider adoption amongst providers, exposing the pervasive disconnect between how hospitals and physicians currently utilize these new technologies in the health care delivery space as opposed to how they would want to take advantage of telehealth’s promise. Notably, previous studies have cited consumer reluctance as a barrier to adoption, but this study’s findings point to cash flow concerns as the main obstacle – specifically, the investments required in infrastructure and technology and issues related to reimbursement.
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