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This Week in Health Care Reform - September 12th, 2014

The decreasing trend in health care spending growth belies the looming threat posed by the increasing price of specialty drugs; the legal challenge to the health care law’s subsidy gets its day in court…again; reports surface that the government’s health care website was hacked earlier this summer; the Administration meets with insurers in advance of the next open enrollment period; and, data shows that the majority of patients are primed to embrace the promise of telehealth.


Week in Review

Spending Growth: Recent projections from federal actuaries indicate that health care spending growth is expected to slow down over the coming decade.  Despite the aging population, the improved economy, and the larger number of people with coverage, numbers released by the Centers for Medicare & Medicaid Services (CMS) last week showed that spending growth remains low by historical standards.  In fact, with the economy continuing to find its footing and with major provisions of the Affordable Care Act coming online this year, the higher estimates for health spending growth for 2014 still come below the average annual growth projected out of CMS’ Office of the Actuary as recently as two years ago.  Still, actuaries went on to forecast that by 2023, total health spending in the U.S. will rise to about one-fifth of the economy, compared to 17.2 percent in 2012.  While experts are left to debate the reasons behind that upswing and what the future may hold for health care in this country, there’s growing evidence that prescription drug spending will only amplify its position as a primary health care cost driver going forward.  In particular, the soaring prices for specialty drugs, which new findings indicate will continue to exert disproportionate influence on total drug spending, and transitively, overall spending on health care. 

Challenge Redux:
Late last week, the U.S. Court of Appeals for the D.C. Circuit announced its decision to grant a rehearing of the case challenging whether or not subsidies on the exchange should be limited to only those states operating their own marketplace or extended to include the federally-facilitated marketplace, as well.  The announcement vacates the decision the court had handed down in July in which a three-judge panel ruled in favor of opponents who had argued against making the subsidies available beyond the state-run exchanges, as spelled out in the law.  The case now goes before a panel of up to 13 judges and eliminates, at least temporarily, its making its way to the Supreme Court.

Website Hacked: It was also reported late last week that a hacker had breached the federal website back in July.  While no data was believed to have been stolen, malicious software was uploaded in an attempt to use the portal in future cyberattacks against other websites.  The security breach was the first confirmed, successful hack of the site through which millions of American signed up for coverage.  Given the troubles that plagued the launch of the website last fall, many believed it was only a matter of time before’s security was compromised.  While questions abound about what the breach may or may not mean for consumers, the ripple effect has already begun, including calls for a Congressional hearing.  Whatever the next steps, it’s abundantly clear to observers that enhancements to the integrity of the government’s website, beyond those that have already been hinted at, should be at the top of the to-do list for newly-established federal health insurance exchange marketplace CEO, Kevin Counihan.

Pre-Enrollment Meeting:
In preparation for the next open enrollment period, Health & Human Services (HHS) Secretary, Sylvia Mathews Burwell, met last week with more than a dozen health insurance plan executives.  The purpose of the meeting was to build on the dialogue concerning affordability on the exchanges and how best to maximize enrollment given the smaller window open to consumers this time around.  On the heels of that sit-down, earlier this week, the Secretary called for an end to the partisan bickering surrounding the health care law, citing the continued comity shared between the public and private sectors in trying to find a path forward for implementation as evidence that Americans want to move on.  She went on to say that it was her desire to move beyond politics and that she was ready to work with both parties to improve the management and operation of, having already told her team that they weren’t there “to fight last year’s battles.”

Ready for Telehealth:
It’s no secret that health information technology has the potential to transform health care.  So, it stands to reason that people should be ready to embrace the application of new technologies in accessing their care.  A new study shows just how eager patients, in fact, are for the widespread adoption of telehealth.  While there remains a preference for in-person, face-to-face visits with physicians, the report found that nearly 70 percent of those surveyed indicated a willingness to participate in a telehealth appointment with their health care provider.  (And, lest you think these sentiments were limited to younger, tech-savvier consumers, a separate study found that baby boomers also stand ready to embrace telehealth.)  On a related note, the Federation of State Medical Boards (FSMB) announced this week that it had finalized its model guidelines for telehealth licensure.  Those rules are aimed at reducing some of the more stringent legal barriers preventing physicians from engaging in the practice of telemedicine, such as speeding the process of approvals which would allow physicians to practice in multiple states, thereby cutting through the tangled web of legal restrictions standing in the way of patients accessing remote care.

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