The James Group Newsletter Vol. 5, Num. 7: ACA Insurance Rewritten, CA Aims to Tackle HC Prices, Ryan Leaves Congress, Opioid Crisis, ACA Standing, FDA Restrictions, CVS Improperly Reporting, UHG Forms Army, Boehler As Director, Reinsurance Pools, MegaMerger


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April 13, 2018 

Volume 5, Number 7

In This Issue

ACA Insurance Rewritten

CA: Aims to Tackle Healthcare Prices

Paul Ryan Leaves Congress

Opioid Crisis Hearing

Where ACA Stands in 2018

FDA Restrictions on Birth Control

CVS Improperly Reported Generics

UnitedHealth Group Gathers An Army

Boehler: New Director for CMMI

Some States Try Reinsurance Pools

Mega-Mergers Changing Medical Care  

TJG On Facebook

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The Washington Post: Trump Administration Rewrites ACA Insurance Rules To Give More Power To States
The rules add two broad exemptions from the ACA’s requirement that most consumers be insured. The change offers escape hatches that will be retroactive two years, even before a recent tax law ends the penalties completely starting in 2019. People living in areas where only one insurer is selling plans in the marketplace now can qualify for a “hardship exemption.” So can people who oppose abortion and live in places where the only available plan covers abortion services. Federal health officials and private researchers have shown that about half of U.S. counties have only one ACA insurer this year. (Goldstein, 4/9)

Source: The Washington Post

California Healthline: California Aims To Tackle Health Care Prices In Novel Rate-Setting Proposal
Backed by labor and consumer groups, a California lawmaker unveiled a proposal Monday calling for the state to set health care prices in the commercial insurance market. Supporters of the legislation, called the Health Care Price Relief Act, say California has made major strides in expanding health insurance coverage, but recent changes haven’t addressed the cost increases squeezing too many families. (Terhune, 4/10)

Source: CA Healthline

The Wall Street Journal: With Paul Ryan's Exit, GOP Loses Advocate For Changes To Retirement, Healthcare
When House Speaker Paul Ryan leaves Congress, the Republican party will lose its most influential advocate for changes to Social Security, Medicare and Medicaid. As Budget committee chairman, a vice presidential running mate to Mitt Romney in 2012, Ways and Means chairman and finally House speaker, Mr. Ryan had pressed for curbs on federal spending on the three programs. These retirement and health care programs are popular with voters, but their costs are rising faster than the funds to pay for them. (Radnofsky and Timiraos, 4/12)

Source: The Wall Street Journal

The Washington Post: The Opioid Crisis: Drug Executives To Testify Before Congress About Their Role In Distributing Powerful Painkillers
Current and former executives with the pharmaceutical distributors that are accused of flooding communities with powerful prescription painkillers have been summoned to testify before Congress about their role in the U.S. opioid epidemic. The hearing, scheduled for May 8 before a House Energy and Commerce Committee oversight panel, has the potential to be a defining moment for the pharmaceutical industry, much like when tobacco executives were called to testify before Congress in 1994. The pharmaceutical executives are expected to face tough questions under oath about why their companies pumped so many highly addictive pain pills into West Virginia and other states, fueling what has become the deadliest drug crisis in U.S. history. (Zezima and Higham, 4/12)

Source: The Washington Post

Modern Healthcare: Where The ACA Health Insurance Exchanges Stand In 2018
Though enrollment in the exchanges slipped and insurers hiked premiums by an average of 30%, the size of the premium tax credits available to most exchange enrollees ballooned enough that the average subsidized shopper paid a lower premium for coverage than the year before. Even so, the individual on-exchange ACA plans remain unaffordable for millions of people who aren’t eligible for financial help. Congress has yet to pass legislation to bolster the market and bring down premiums, and is unlikely to do so before insurers must file 2019 rates later this spring. (Livingston, 4/11)

Source: Modern Healthcare

The Associated Press: FDA Puts Restrictions On Birth Control Implant But No Recall
The Food and Drug Administration said only women who read and have the opportunity to sign a brochure about the risks of the device will be able to receive the implant made by Bayer. The checklist of risks must also be signed by the woman's doctor. The new requirement comes almost two years after the FDA added its strongest warning to Essure, citing problems reported with the nickel-titanium implant. The agency also ordered Bayer to conduct a study of the device's safety. (4/9)

Source: The Associated Press

Stat: Aetna Auditor Says CVS Improperly Reported Generic Prices To Medicare
The CVS Caremark pharmacy benefit manager improperly reported generic drug prices to the federal government, causing Medicare and its beneficiaries to overpay for medicines, while pocketing a difference in pricing, according to a lawsuit filed by an actuary at the Aetna health insurer. The lawsuit revolves around complicated, behind-the-scenes contracts between pharmacy benefit managers and Medicare Part D plans, and the pricing that must be reported to the Centers for Medicare and Medicaid Services. (Silverman, 4/9)

Source:  Stat

Bloomberg: 30,000 Strong And Counting, UnitedHealth Gathers A Doctor Army 
Disruptors are circling the health-care industry. UnitedHealth Group Inc., the biggest U.S. health insurer, has built an army of tens of thousands of physicians to fend off invaders. Health care in the U.S. has been plunged into a high-speed reconfiguration that could redraw longstanding relationships between patients, doctors, drugmakers and insurers. Outsiders such as Inc. and Walmart Inc. are looking for ways to shake up the business. (Tracer, 4/9)

Source: Bloomberg

The Hill: Trump Taps New Director For Office On Medicare Reforms
The Trump administration on Friday announced a new director for the Center for Medicare and Medicaid Innovation (CMMI), an office that could be at the center of efforts to shake up and reform the health system. Centers for Medicare and Medicaid Services Administrator Seema Verma told staff in an email that Adam Boehler, the former CEO of Landmark Health, a home-based medical care company, will start as the director of the office next week. (Sullivan, 4/6)

Source: The Hill

Stateline: To Curb Rising Health Insurance Costs, Some States Try 'Reinsurance Pools'
A couple of years ago, the health insurance exchange in Minnesota – MNsure – was in deep trouble. Health insurance premiums for individual policies had shot up by as much as 67 percent, among the steepest increases in the country.  Insurers were abandoning the market, leaving 116,000 Minnesotans with scant choices. The Minnesota Legislature offered a solution: a $271 million, publicly funded reinsurance pool that would help health insurance companies pay the most expensive medical claims, thereby lowering overall insurance premiums. The hope was that backstopping the insurers would stabilize the market and halt the rocket-like rise in premiums. (Ollove, 4/9)

Source: Stateline

The New York Times: The Disappearing Doctor: How Mega-Mergers Are Changing The Business Of Medical Care
Is the doctor in? In this new medical age of urgent care centers and retail clinics, that’s not a simple question. Nor does it have a simple answer, as primary care doctors become increasingly scarce. “You call the doctor’s office to book an appointment,” said Matt Feit, a 45-year-old screenwriter in Los Angeles who visited an urgent care center eight times last year. “They’re only open Monday through Friday from these hours to those hours, and, generally, they’re not the hours I’m free or I have to take time off from my job. (Abelson and Creswell, 4/7)

Source: The NY Times


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