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This Week in Health Care Reform - July 31st, 2015

Five years in, the health care law remains as divisive as ever; new cholesterol drugs threaten to exacerbate an already unsustainable cost trend; telehealth continues to offer up new solutions to old problems; and, state exchanges grapple with their future.


Week in Review

Polling: Despite having withstood an unending stream of political attacks, not to mention repeated challenges to its Constitutional legitimacy, the Affordable Care Act remains as politically divisive as it was when it was first enacted.  A new survey from inside-the-Beltway publication Morning Consult found that attitudes towards the health care law remain stagnant and entrenched along party lines.  Generally, a plurality of respondents (37 percent) said that they wanted Congress to improve the law.  However, when broken out by party affiliation, responses were predictably partisan, with Democrats largely wanting lawmakers to either expand the law or allow it take effect, while Republicans either wanted changes to it or for it to be repealed outright. 

Havoc on the Horizon: As diagnosed cases of hepatitis C in states across the country sharply increase, stakeholders across the health care spectrum are warning that our system is in danger of collapsing under the weight of the high-priced drugs being prescribed to treat the liver-destroying disease.  Unfortunately, with pharmaceutical sales soaring for these manufacturers, it doesn’t look like that’s about to change.  Distressingly, new drugs, about to hit the market, seem poised, if anything, to send our health care system, once and for all, teetering over the brink.  A new class of cholesterol drugs are already threatening to “wreak financial havoc” as described by Express Scripts, the nation’s largest pharmacy benefits manager.  Separately, a new drug aimed at treating cystic fibrosis is already coming under heavy fire, owing to its manufacturer’s decision to price the treatment at $259,000 per patient annually.  However, a group of prominent cystic fibrosis doctors are fighting back, taking their previously private – and largely fruitless – dialogue with that drug’s manufacturer, Vertex, public.  Whether or not their efforts are successful in introducing reason and social obligation into the discussion remains to be seen, but the issue writ large has begun to gain traction beyond prescribed patient populations as more and more people find themselves wondering, “How high is too high?”

Digital Solutions:
Patients and doctors continue to express growing comfort with the role that technology can play in eliminating the barriers that traditionally stood in the way of getting care to the people who need it when it’s needed.  That’s opened the door to the exploration of new and innovative ways that telehealth and predictive analytics can enhance the delivery of health care.  But, challenges remain.  Whether it’s states accommodating telehealth’s widespread adoption by enacting the requisite policies or the federal government finding a way to encourage telehealth’s utilization by taking a look at the existing reimbursement model, systemic changes are needed.

State of State Exchanges:
As state-run exchanges begin to normalize operational expenses, many find themselves struggling to make ends meet, largely owing to a combination of higher-than-expected costs and lower-than-anticipated enrollment.  Experts estimate that of the twelve states and the District of Columbia that elected to establish their own marketplaces, about half of them face financial difficulties.  What this means going forward isn’t immediately clear, but it’s prompted many of them to talk about ‘shared services’ as a means of exploiting whatever economies of scale they might be able to leverage.

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Looking Ahead

A new study from the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) projects health care spending to increase by 5.8 percent on an annual basis through 2024.  Prior to last year, spending rates were at about 4 percent annually, but that trend was reversed with the launch of the Affordable Care Act’s insurance exchange marketplaces and the expansion of Medicaid.  The analysis also points to our aging population’s higher health care costs and the explosion of costly new high-priced medicines as drivers of spending.

And, speaking of CMS, this week marked the 50th Anniversary of Medicare and Medicaid.  As celebrants honored the occasion, recognizing the achievements of these historic safety net programs, thoughts turned to what the future holds for Medicare and Medicaid

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