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This Week in Health Care Reform - September 19th, 2014

As the second open enrollment period nears, stakeholders brace for another rocky rollout; Gilead hints at a price hike for its next generation hepatitis C drug; telemedicine continues its march towards widespread adoption; and, health care’s preeminence as a campaign issue remains shrouded in mystery.


Week in Review

Enrollment Concerns: With just under two months to go before the next open enrollment period is slated to get underway, health care stakeholders find themselves engaged in more than a little hand-wringing.  While IT issues top the list of concerns, experts fear that potential complications, beyond the technological, will expose underlying problems with the law itself.  But, that’s not to give those worries over the operational status of the government’s exchange marketplace website short shrift, as this week, nonpartisan investigators at the Government Accountability Office (GAO) concluded that continues to have significant security flaws, putting millions of users’ personal information at risk.  While acknowledging the steps taken by the Centers for Medicare & Medicaid Services (CMS) to enhance security and privacy protections, GAO warns that weaknesses and possible exposure points remain.  The report goes on to identify more than 20 specific security issues that the site’s administrators must resolve related to who has access to the system, who is able to make changes once inside it, and what contingency planning exists should the complex network fail.  Despite these heightened security concerns, recent polling doesn’t depict a public that’s overly concerned with data breaches on the health insurance exchange marketplace.  A new survey released by Morning Consult found that more than half of those polled (52 percent) currently believe that the information on the exchange is secure.  Unsurprisingly, lawmakers have flocked to the issue, with House Republicans on the Oversight & Government Reform Committee holding a hearing yesterday examining what went wrong and where we go from here.  For their part, Democrats sought to allay any concerns by offering up a Homeland Security official as their witness to testify that no consumer data was affected by recent breaches to the website. 

Gilead Pricing:
To call Gilead Sciences’ decision to price its hepatitis C drug, Sovaldi, at $1,000-a-pill unpopular would be an understatement.  Already, stakeholders across the health care spectrum have raised the alarm over what the drug’s price, not only threatens to do to the health care system today, but portends for the future, as many more specialty drugs come barreling down the pipeline.  So, given all the angst and bad publicity that have trailed the pharmaceutical company in recent months, one would only assume that the next generation of its breakthrough drug would provide Gilead with exactly the kind of pricing olive branch the company would be eager to grab ahold of with both hands.  One would be wrong.  As the drugmaker prepares to launch the first all-oral treatment for the liver-damaging disease, there’re indications that the new drug is going to be more expensive than the current regimen, which includes Sovaldi and two older medicines and totals $95,000.  On a related note, a new analysis performed by CVS Health was released this month showing that discontinuation rates of patients taking Sovaldi were four times higher than those observed during the drug’s trial period.  While quick to point out that no evidence exists to support a correlation between patients’ adherence to the prescribed treatment and the drug’s exorbitant cost, the debate continues to play out in public.

Health, Care, & IT:
Telehealth, it would seem, is quickly approaching its tipping point.  Already, practitioners, payers, providers, and patients have espoused the benefits on offer of widespread application of technological advances to the delivery of care.  Now, employers seem poised to propel telehealth forward in the next meaningful way.  In a survey conducted by the National Business Group on Health (NBGH), nearly half of all employers reported that they planned to provide telehealth services in the states where they are allowed to next year.  However, it’s that qualifier that speaks to the barriers standing in the way of a wider embrace of telehealth – barriers that were discussed at a roundtable meeting of health industry leaders hosted by the Senate Special Committee on Aging earlier this week.

Health Care & the Midterms:
As we approach the midterm elections in earnest, the political rhetoric surrounding the health care law and its implementation on the campaign trail will undoubtedly increase.  While some believe that what happens this November has the potential to greatly impact where the Affordable Care Act goes from here, others aren’t so sure.  (In fact, one recent analysis found that over the past year, the issue has practically vanished, at least from Congressional floor speeches.)  Regardless of where the issue registers with voters, it’s hard to deny that the law itself will continue to resonate with them as they make their way to the voting booth.

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Looking Ahead

On the eve of the next open enrollment period, expert analysis takes a closer look at how states’ decisions regarding the Affordable Care Act have impacted implementation.  Meanwhile, now that we’ve seen the health care law in action, observers say it still has a long way to go. 

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