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This Week in Health Care Reform: September 22nd, 2017

Stakeholders highlight their efforts in the ongoing fight against opioid misuse; Senate leaders target next week for their latest attempt to replace the Affordable Care Act; lawmakers are urged to protect Medicare’s Special Needs Plans; and, an analysis shows the hidden costs of hospital consolidation.

Week in Review

Focus on Opioids: As communities across the country continue to grapple with the opioid epidemic, state law enforcement officials are broadening their investigation into the role that the opioid industry itself has played in the worsening crisis.  Earlier this week, attorneys general from most states served subpoenas to five prescription painkiller manufacturers and three distributors requesting information on marketing and sales practices.  This follows immediately on the heels of a separate request made by the attorneys general to insurance companies asking them to offer incentives for other forms of non-opioid pain treatment.  For their part, health plans have already begun to enact initiatives aimed at addressing the issue.  These efforts, along with those of other health care stakeholders, were spotlighted in a series of briefings across Washington recently, including one such discussion hosted by the Patient-Centered Outcomes Research Institute (PCORI) focusing on the importance of finding evidence-based strategies to tackle the opioid epidemic.  Separately, the Alliance for Health Policy hosted an event exploring the role that integrated care can play in helping patients and providers better manage the chronic pain associated with physical and behavioral health issues.  Finally, the Association for Behavioral Health and Wellness (ABHW) hosted a panel discussion examining health plan’s perspectives on the trends, challenges, and best practices that they’ve deployed to combat opioid misuse.  Be sure to check out the Health Action Network on Twitter for highlights.

Senate Vote: Efforts to find bipartisan solutions that would bring stability to the individual market were put on the backburner this week as legislative momentum built behind Senate Republicans’ latest attempt to repeal the Affordable Care Act.  That bill, proposed by Sens. Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana), is now slated to come to the floor of the Senate for a vote next week, absent a comprehensive analysis by the nonpartisan Congressional Budget Office (CBO), whose score isn’t expected until after the legislative window (opened under budget reconciliation) closes at the end of the month.

As previously covered, Special Needs Plans (SNPs) are scheduled to expire at the end of 2018.  These health care plans, originally authorized under the Medicare Modernization Act of 2003, were designed to lower costs, while offering some of Medicare’s most vulnerable beneficiaries – those with multiple chronic conditions, living in facilities, or dually-eligible for Medicare and Medicaid – access to enhanced quality care.  Stakeholders have already spoken up about the important role that SNPs play in connecting 2.4 million high-need, high-cost Medicare beneficiaries with the kind of specialized care that makes a difference in their lives.  We need our Health Action Network members to also weigh-in and urge your lawmakers to protect vulnerable enrollees by reauthorizing SNPs.

Hospital Consolidation:
Rising health costs continue to impact consumers’ ability to access affordable, quality care.  Alongside rising drug costs and persistent market instability, increased hospital and provider consolidation also exerts upward pressure on our health care cost curve.  New research points to continued concentration of health care systems across markets all over the country, such as the proposed combination of the two dominant hospital systems in Northeast Tennessee and Southwest Virginia, highlighted previously.  That merger just won approval from Tennessee’s Department of Health and is currently awaiting a decision in Virginia, despite health economists’ inability to find one incidence where hospital consolidation didn’t also result in higher prices for consumers.  Also worth noting is the lack of evidence linking that trend to better care coordination or increased innovations being brought to market.  Against that backdrop, it’s not hard to understand why experts are casting a wary eye on recently announced deals in both Kentucky and Georgia.      

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A new interactive dashboard from the Modern Medicaid Alliance allows users to explore the important role that Medicaid plays in the lives of millions of beneficiaries.  Meanwhile, a separate study highlights the value that Medicaid Managed Care brings to states.

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