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This Week in Health Care Reform: July 21st, 2017

Lawmakers regroup to figure out next steps on health care reform; a critical Medicare health care plan comes up for reauthorization; and, millions of Americans feel the burden of rising drug prices.

Week in Review

Next Steps: Despite their ongoing efforts, Senate GOP leaders were forced to pull their health care replacement bill earlier this week as the latest vote count indicated the bill lacked the necessary support to pass.  Attention quickly shifted to bringing a straight repeal bill to the floor for a vote next week, prompting a bipartisan group of governors to urge federal lawmakers to come together, instead, to find a way forward that both sides of the aisle could agree to.  Centrist House Republicans and Democrats – already scheduled to meet on Tuesday – did just that, as members from the GOP’s Tuesday Group and the New Democrat Coalition spent the bulk of their meeting discussing ideas on a possible bipartisan approach to health care reform legislation.  Meanwhile, Republican Senators were invited to the White House for lunch on Wednesday as the Administration sought to get members on the same page.  More than two dozen then went on to hunker down late into the evening in a last-ditch attempt to figure out next steps on the stalemated health care bill.

SNP Reauthorization: As has been previously covered (here and here), Congress is expected to take up legislation this year to reauthorize Special Needs Plans (SNPs), health care plans designed to lower costs and improve quality of care for some of Medicare’s most vulnerable beneficiaries, such as those with multiple chronic conditions, living in nursing homes, or dually-eligible for, both, Medicare and Medicaid.  SNPs were initially authorized by the Medicare Modernization Act in 2003.  Since then, they’ve grown significantly, with more than 2.4 million beneficiaries now enrolled.  With a growing body of evidence showing that SNPs provide higher quality health care than fragmented delivery systems or traditional fee-for-service, these health care plans continue to be recognized as a valuable care delivery model for high-need patients.  But, their ability to provide that level of care depends on certainty and flexibility.  While SNPs have been regularly reauthorized by Congress since their initial authorization, without further Congressional action, they are scheduled to expire at the end of 2018.  Learn more and keep an eye out to see how you can help protect SNPs.

Rx Burden:
Not to get lost amidst the drama surrounding health care reform is the increasing burden that high-priced prescription drugs are placing on our health care system.  As stakeholders continue to draw attention to the issue, a new analysis puts a number to exactly how many have been impacted by the drug pricing crisis.  In a survey released this week, Consumer Reports found that at least 28 million Americans have experienced a spike in the cost of their prescriptions in the past year.  Alarmingly, for 4 million of those, the price was high enough to force them to walk away without their medications altogether.      

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With legislative attention focused on next steps for health care reform, the Administration this week made the decision to continue funding – at least for this month – the critical cost-sharing reduction (CSR) subsidies that help low-income people afford their co-pays, deductibles, and other out-of-pocket costs associated with their coverage.  And, while the move was met with no small amount of relief, the lack of certainty surrounding CSR funding threatens to further destabilize the individual insurance market exchanges.

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