THIS WEEK IN REVIEW: Monday, Mar. 5th – Friday, Mar. 9th
March Madness came a week early, with the health policy landscape looking particularly active these past few days. We’ll begin with a new study this week which offered the harrowing prediction that health insurance premiums could increase by up to 90 percent in the next three years. Against that backdrop, it is no surprise that there was a flurry of action from the states, the Hill and the White House on how to control health insurance costs this week. While a coalition of healthcare providers and insurers pressured Congress to fund the Affordable Care Act’s (ACA) cost-sharing reduction (CSR) payments and also to establish a reinsurance program, Republicans in the House of Representatives seemed resigned to fact that the inclusion of the CSR payments would be necessary to pass the omnibus government spending bill by March 23 (to avoid another government shutdown). It may not be as straightforward as it seems, though, with the Center for Budget and Policy Priorities warning that reauthorizing CSR payments at this point may do more harm than good.
Still, seeing the inevitability of appropriations for CSR payments, the White House reportedly offered its support for the funding. In addition, however, they requested that the spending bill also provide support for the expansion of health savings accounts, an increase in the age rating ratio (which would allow insurers to charge older Americans five times as much in premiums than younger people), and support for short-term, limited-duration (STLD) insurance plans. While state responses to the STLD plans have been varied, a coalition of 17 Democratic state attorneys general blasted another Trump administration approach to health insurance when they submitted a formal comment letter to the Department of Labor in opposition to the allowance of association health plans (AHPs).
Another factor in predicted rise in health insurance prices is the Trump administration’s repeal of the individual mandate (effective January 1, 2019), which was back in the news this week as well. Some states are considering workarounds to reinstitute the mandate, like Maryland’s consideration of health insurance “down payment” legislation in both chambers of the Statehouse. Still, despite many states vowing to go it alone when it comes to mandating insurance, most continue to struggle to galvanize the support to pass state legislation.
While cost and coverage in the individual marketplace loomed large in this week’s news, the ongoing debates surrounding Medicaid’s future raged on as well. After five states applied for waivers to place lifetime caps on Medicaid benefits, Democrats on the House Energy and Commerce Committee drafted a letter to the Secretary of Health and Human Services (HHS) strongly advising the agency against approving these requests. Arkansas became the nation’s third state to gain approval to institute work requirements in their Medicaid program, they did not get approval from the Centers for Medicare and Medicaid Services (CMS) to contract their program by an estimated 20 percent. Oklahoma also joined the list of states exploring a plan for Medicaid work requirements—a list that has now reached the double digits. Utah, meanwhile, decided to move forward with their unique approach which would both partially expand their Medicaid program and call for work requirements.
Speaking of unique approaches, the Trump administration finally addressed the Idaho proposal to change their insurance marketplace to allow higher rates for individuals with pre-existing conditions and to disregard the ACA’s minimum essential benefits for an insurance plan. CMS Administrator Seema Verma wrote to Idaho Governor Butch Otter and advised him that the ACA remained the law of the land, and that her duty was to uphold the law. Despite the letter, Gov. Otter remained convinced that the Trump administration will work with him to fine-tune his state’s proposal.
News regarding the opioid epidemic this week was rather discouraging, with new data from the Centers for Disease Control and Prevention (CDC) showing that emergency room visits for suspected opioid overdoses were up by 30 percent between July 2016 and September 2017. With news that the crisis rages on, Governors took to Capitol Hill on Thursday to advocate for more funds to fight the epidemic. The governors—along with groups of doctors and health-care advocates—are also pushing Congress to allow Medicaid funds to be used to treat addition. There is hope looking forward, as the National Quality Forum plans to release new guidelines on opioid stewardship for providers on March 12, and the House Energy and Commerce Health Subcommittee plans to consider more than 20 pieces of bipartisan opioid legislation starting on March 21.
On to another prescription drug crisis—that of drug pricing—two large health insurers made big waves this week. UnitedHealthcare announced that it would no longer keep the millions of dollars in discounts it receives from drug companies, but will instead begin passing along their rebates to patients. HHS Secretary Alex Azar immediately praised the move as the type of private sector innovation the Trump administration is championing, and foreshadowed more to come. Meanwhile, Cigna announced a $52 billion agreement to acquire Express Scripts, the nation’s largest pharmacy benefit manager (PBM). The merger—the latest in a recent wave of consolidations (e.g., UnitedHealth/OptumRx or CVS/Aetna)—is likely to similarly draw significant antitrust scrutiny from the Trump administration before becoming official.
Last, but certainly not least, women’s reproductive health and rights were front and center from a number of angles this week. Amidst reports of strong support from the Trump administration for abstinence-only education, HHS confirmed that discretion over Title X funding has been left entirely to Valerie Huber, the acting deputy assistant secretary for population affairs and a longtime proponent of sexual risk avoidance (through abstinence). Meanwhile, on the Hill, a showdown looms after Democrats vowed to oppose the omnibus spending package if it cuts off funding for Planned Parenthood and Rep. Tom Cole (R-OK), chairman of the Appropriations health subcommittee, doubled down and stated that the GOP would not vote to fund it.
From the states, the Mississippi legislature passed a measure on Thursday that—once signed by Gov. Phil Bryant in the coming days—will disallow all abortion after 15 weeks, making it the nation’s earliest abortion ban. Looking forward, legislators and advocacy groups are looking toward March 20, when the Supreme Court will begin oral arguments in the case National Institute of Family and Life Advocates v. Becerra. The case will determine whether a California law violates free speech for anti-abortion crisis pregnancy centers by requiring them to post signs explaining the availability of state-subsidized family planning services (including abortion).
So, take a minute and reflect on the 1,061 words it took us to tell you about health policy this week. All of the week’s action and controversy only set up a busier, more active week ahead. We’ll have it all covered for you next time so, until then, enjoy your week and GO HOOS!