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This Week in Health Care Reform - September 26th, 2014

A new analysis forecasts what the future holds for Medicare Advantage; imperfection predicted for the exchange website on the eve of open enrollment; technology positions itself as a positive health care disruptor; better tracking is urged for financing of the health care law; and, Sovaldi continues to send out ripples.


Week in Review

Medicare Advantage Forecast: Late last week, the Centers for Medicare & Medicaid Services (CMS) released their latest landscape analysis containing data on the Medicare Part D and Medicare Advantage (MA) programs.  In terms of the latter, MA continues to attract beneficiaries at a fast clip, with enrollment projected to exceed 16 million seniors and persons with disabilities in 2015.  However, the announcement was immediately tempered with more than a little caution as experts and industry analysts were quick to point out that any growth in the Medicare Advantage population would be despite the substantial cuts to the program imposed under the Affordable Care Act – cuts, they go on to warn, that could erase these gains in the coming years.  CMS’ forecast also estimated an average 4 percent increase in MA premiums for next year, which some argue is to be expected, given the uncertainty surrounding the long-term prospects of the program, citing as evidence, the 19 percent decrease in $0 premium MA plans for 2015. 

Enrollment II:
As final preparations continue ahead of the next open enrollment period, it was reported that 7.3 million people were paid enrollees through the health insurance exchange marketplaces by the end of the summer.  Despite that latest tally being significantly lower than the estimates coming out of the Administration earlier this year, supporters feel it’s worth mentioning that that number is still much higher than the original 6 million enrollees forecasted by the Congressional Budget Office (CBO) before last year’s enrollment period opened.  As critics are left to wonder if they’ll ever see a final enrollment count they can trust, efforts continue apace to ensure this year’s enrollment period builds on last year’s success.  While experts are able to offer up some advice to would-be enrollees, there’s one sure thing nobody should expect when they visit to sign up: Perfection.  In testimony offered up to a House Committee last week, CMS Administrator, Marilyn Tavenner, told members that there will be “visible improvements, but not perfection” on the federal government’s exchange website.  (Given the issues that have plagued since its rocky rollout last year, you’d be forgiven if you counted yourself amongst the majority of Americans expecting anything but perfection on the troubled site this fall.)  Undeterred, she went on to promise the Committee that, if anything, cyber-security would be enhanced and that the website would be better protected by the time enrollment opens in less than two months.  However, in a separate speaking engagement on Wednesday of this week, Health & Human Services (HHS) Secretary, Sylvia Mathews Burwell, stopped short of making such promises, pledging, instead, that officials are “continuing, step-by-step” in their efforts to get the website ready.  Meanwhile, earlier this week, it was announced that is also undergoing a makeover that will allow for easier sign-ups and a smoother, friendlier user experience.  That announcement was quickly followed by reports that the tab for implementing the health care law now stands at $73 billion since it was enacted in 2010, with the federal government spending more than $2 billion, alone, on constructing and fixing

Disruptive Force: It’s hard to deny that technology has the power to change lives.  One need only stop on the street and look up to see how many other people have their noses buried in their smartphones, tablets, or other devices, to get a sense of the extent to which technology has helped bridge the distances that proximity and geography would have us surrender to.  So, it stands to reason, as technology wends its way through every sector of our economic landscape, health care and its delivery, should be no different.  New advances in wearable health monitoring devices, electronic medical records, and virtual doctor visits, are all having a disruptive influence on how people are accessing their health care.  And, as opportunities continue to appear on the horizon, it becomes that much more crucial that the tangled web of regulations governing telehealth be sorted out so as to encourage its widespread adoption, rather than impede it.

GAO Recommendations:
As mentioned above, billions of dollars have been spent to date in getting the Affordable Care Act up-and-running.  This week, it was reported that $3.7 billion has been spent this year, alone, to build and promote the health care law’s newly established online marketplaces.  In an audit released Monday by the Government Accountability Office (GAO), federal investigators advised CMS to do a better job of tracking its implementation financing, pointing to the Agency’s outdated record system and its lack of a proper tracking mechanism that could be used to determine the efficacy of its spending.  GAO went on to say that it was unable to substantiate several exchange-related expenses and urged CMS to do a better job of keeping its house in order.

Sovaldi Dissonance:
In what some are calling the ‘other war on drugs’, specialty drugs continue to find themselves the topic of much heated debate.  Leading the discussion, as has been the case, is Sovaldi, Gilead’s breakthrough hepatitis C drug.  And, at $84,000 for a typical course-of-treatment, it’s easy to see why.  With an estimated patient population of more than 3 million Americans, Sovaldi has already wreaked havoc on businesses’ bottom lines, not to mention state budgets across the country.  Despite recent data showing a slowdown in the drug’s use, there’s a growing body of evidence warning that Sovaldi represents an unsustainable trend with so many more specialty drugs expected to make their way to market.

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Despite what many political prognosticators would have us think, it’s looking like health care is still going to play a big role in the midterms.  And, there’s growing concern that complicated Affordable Care Act tax forms could cause problems next year. 

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