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This Week in Health Care Reform - September 25th, 2015

A bill to roll back the small group market expansion heads for a vote; in something of a twist, an old drug (with a new price) brings even more attention to the reckless pricing trend at work in the pharmaceutical industry; warnings surface that sign-ups during open enrollment might be harder than ever; and, the popular Medicare Advantage program continues to attract beneficiaries.


Week in Review

Small Group Vote: As has been covered in recent weeks, the effort to roll back a destabilizing new provision of the health care law has steadily gained legislative momentum with lawmakers.  Scheduled to go into effect next year, the small group market expansion would change the definition of small employers to include businesses with up to 100 workers.  Unless repealed, the expansion would have far-reaching implications for the affordability and stability of coverage that millions of employees and their families depend on.  In short, the definition change would impose onerous new requirements on mid-sized businesses, causing disruption for 3.4 million people.  Additionally, nearly two-thirds of the workers in these businesses would face premium increases of 18 percent as a result of the expansion.  Fortunately, bipartisan legislation has been introduced in both the U.S. House of Representatives and the Senate that would enable states to maintain their current definitions for the small group market, thereby promoting stability in the market and avoiding coverage disruptions for small- and mid-sized workers and their families.  The House is scheduled to take up their version of the bill, H.R. 1624, on Monday, which is why we need Health Action Network members to reach out to their Representatives now and ask them to vote ‘Yes’ to the bill and help to protect the millions of American workers and their families that would be impacted by the expansion. 

Scorched Earth:
Drug company Turing Pharmaceuticals found itself at the center of a media and political firestorm this week when the start-up, run by former hedge fund manager, Martin Shkreli, raised the price of one of its drugs overnight by more than 5000 percent.  While the issue of escalating drug prices has elbowed its way into the public consciousness, till now, that’s mostly been as new drugs have made their way to market.  In the case of Turing, however, the issue took a decidedly different path to center-stage.  The drug at the heart of this frenzy, Daraprim, used to fight a serious parasitic infection, is actually more than 60 years old and was only acquired by Turing in August, at which time the company immediately raised the price from $13.50 a tablet to $750, bringing the annual cost of treatment for some patients taking the medication to hundreds of thousands of dollars.  Meanwhile, another drug, cycloserine, prescribed to combat tuberculosis, caused ripples of its own when it was discovered that a similar strategy of acquisition and price-gouging had been employed, this time by Rodelis Therapeutics, who had also acquired the drug last month before promptly raising the price from $500 for 30 capsules to $10,800.  In the wake of these mind-boggling increases surfacing, both companies rescinded their prices.  In the case of Rodelis, that saw the company agree to return cycloserine to the nonprofit organization from which it had acquired the drug, while Turing has yet to disclose the new price of Daraprim.  The damage, however, has already been done and an already beleaguered pharmaceutical industry now finds itself in the crosshairs of both the public and the lawmakers they elect to protect them from these harms.  As research comes to light showing just how much Americans are overpaying for some of these drugs, the issue has begun to find serious traction on the campaign trail.  With dwindling faith in Congress’ ability to tackle the issue with so many other priorities on its already-overstuffed agenda, candidates are beginning to offer up proposals of their own to combat this alarming trend.

Enrollment Prediction:
On the eve of the Affordable Care Act’s third enrollment season opening, a top official cautioned that this year’s open enrollment might be their toughest one yet.  More than 10 million people are still without coverage, despite being able to purchase it through either the federal insurance exchange marketplace or via the one established by their state, often with the benefit of federal subsidies to offset premiums.  While some are just resistant to the idea of enrolling, many of them are younger, poorer, or just harder to reach, and getting these people to sign up will be a challenge, Department of Health & Human Services (HHS) Secretary Sylvia Mathews Burwell said during a speech earlier this week.

Medicare Advantage Enrollment:
New data from the Centers for Medicare & Medicaid Services (CMS) shows that 17.7 million seniors and persons with disabilities are now enrolled in Medicare Advantage plans.  With open enrollment in Medicare a few short weeks away, signs point to the popular program continuing to attract beneficiaries, largely owing to its focus on coordinated care.  However, the stability of the program depends on keeping intact the underlying payment structure that allows Medicare Advantage to focus care where and when it’s needed most.  Learn more about ways you can get involved in the fight to protect this important program by visiting the Coalition for Medicare Choices.

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Looking Ahead

As Americans’ attitudes towards their health care continue to evolve, and as consumer issues make their way onto the health agenda, experts wonder what role incentives might play in our health care decision-making in the future. 

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