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HEALTH ACTION NETWORK - ADVOCACTES FOR BETTER HEALTH CARE SOLUTIONS

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This Week in Health Care Reform - July 18th, 2014

A powerful Senate Committee steps into the Sovaldi fray, as forces marshal against the breakthrough drug’s astronomical price; telehealth champions continue to make advances; the uninsured rate sees a precipitous drop under the health care law; and, the House authorizes a lawsuit against the Administration.

 

Health Care Reform

Sovaldi Angst: It’s becoming increasingly difficult for any substantive conversation on the cost of health care in this country to not eventually run up against the buzzsaw that is the rising price of specialty drugs.  Serving as poster child for this alarming trend is, of course, Gilead Science’s breakthrough hepatitis C drug, Sovaldi.  At $84,000 for a typical course of treatment, it’s not hard to see why.  Already, the drug – really, Gilead’s decision to price it at $1,000-a-pill – has drawn the ire of providers, payers, employers, and just about every other stakeholder across the health care spectrum.  This week, however, lawmakers upped the ante, formally requesting detailed pricing information on Sovaldi.  In a letter to the drug’s manufacturer, Senate Finance Committee Chairman Ron Wyden (D-Oregon) and senior Finance Committee member Charles Grassley (R-Iowa) asked Gilead to defend Sovaldi’s price, citing its well-documented impact on federal and state health care programs and budgets.  (Their request comes on the heels of House Democrats calling for a hearing of their own last week into the drug’s price.)  The Senators’ call for increased transparency was immediately applauded by observers.  With the spotlight squarely focused on the issue, the debate continues to play out in the press, in policy circles, and across the web, as stakeholders on both sides of the issue look to seize control of the narrative.  Defenders of the drug’s price argue that the short-term cost of Sovaldi is far less than the long-term costs associated with allowing hepatitis C to advance in patients afflicted with the liver-destroying disease.  Opponents, however, frame that argument as a false choice, refusing to cede the social and moral high ground that necessarily questions Gilead’s decision to price the drug so exorbitantly.  New polling would suggest that Americans overwhelmingly agree with them, too.  In a survey released this week by Morning Consult, 82 percent of respondents labeled Sovaldi’s price tag as “unacceptable.”  With Gilead’s first quarter net profits nearly tripling, owing in large part to Sovaldi (which helped the manufacturer generate record-shattering sales of $2.27 billion), it’s clear that the court of public opinion probably won’t hold much sway in the ongoing debate.  But, with hard choices already having to be made by some of the company’s largest customers, not to mention the increased legislative scrutiny it now faces, Gilead, and by extension, the pharmaceutical industry, is running out of ways to justify murky pricing determinations.   

Telehealth Support:
Advances in technology continue to influence the way we interact with the world around us.  So, it stands to reason, why should health care be any different?  That’s the question that continues to reverberate across the sector as stakeholders look to leverage advances in telehealth to better serve patients and consumers, while also improving efficiencies in the delivery of health services.  In addition to digital health records, the increased availability of virtual doctor visits has also begun to reshape traditional views of physicians’ offices.  Gone are the days when a patient’s ability to get in to see a medical provider was limited to proximity.  New technologies are allowing for even greater access across ever greater divides.  Despite the promise on offer, however, barriers do still exist to the widespread adoption and deployment of telehealth.  As with most advances, the tools being made available are quickly outgrowing the regulations that govern their utilization.  But, gains are being made across the country as regulators and lawmakers begin to wrap their legislative arms around the advent of these new technologies and practices.    

ACA & the Uninsured:
While there are many measures at our disposal with which the Affordable Care Act’s efficacy can be gauged, one particularly telling benchmark is its impact on the level of the uninsured population in this country.  Regardless of your political persuasion, it’s hard to deny that, by at least that measure, the health care law has shown itself to be capable.  Survey after survey (after survey) continues to show a decline in the number of uninsured people since the start of open enrollment last year.  In fact, one of those studies recorded its lowest ever uninsured rate.  Taking it a step further, another one of those studies went on to find out that the majority of those surveyed were pretty satisfied with their coverage, too.  But, that’s not to say there isn’t room for improvement.  A completely unrelated study indicates that officials would do well to improve the consumer experience ahead of the next open enrollment period.

Waiver Lawsuit:
Lest we forget how politically charged the Affordable Care Act remains in this country, House Republicans this week sought to remind the public (and, some would say, the electorate) that not everyone in Washington has fully embraced the polarizing law.  As revealed in a draft resolution last week, GOP members in the lower chamber, led by House Speaker John Boehner (R-Ohio), were moving forward with their plan to sue the Administration for failing to enforce the Affordable Care Act; specifically, the law’s employer mandate, which has already been delayed twice.  While on the surface it may seem counterintuitive for opponents of the law to bring a lawsuit against its administrators for failing to administer it, the larger issue at work here, at least, according to House Republicans, is the repeated abuse of executive power demonstrated by the President in implementing his signature law.  As lawmakers and constitutional experts debate the merits of the lawsuit, others are left to ponder the ramifications of what it would mean should the suit be successful.

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Looking Ahead

Technical and logistical problems abound ahead of the second open enrollment period, even as officials look to find a new contractor to run the troubled website.  Meanwhile, an unexpected wrinkle emerges as confused enrollees clamor for assistance in understanding their coverage.



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