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The James Group Newsletter Vol. 5, Num. 8: Hosp Contrib to High HC Prices, Lifetime limits on Medicaid, $15b Spending Cuts, Drug Plans Drop, MD Insurers Seek Prem Hikes 2019, Walmart Opioid Restrictions, E.Coli, Expand Veteran HC, CVS/Aetna Deal, Price: ObamaCare Indiv Mandate

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May 8, 2018 

Volume 5, Number 8

In This Issue

Hospitals Contribute to High Healthcare Prices

Lifetime Limits on Medicaid

$15 Billion in Spending Cuts Proposed

Drop of Drug Plans

MD Insurers Seek Premium Hikes for 2019

Walmart Opioid Restrictions

E. Coli Outbreak

Proposal to Expand Private HC for Veterans

CVS Moving Forward with Aetna Deal

Price: ObamaCare Individual Mandate

TJG On Facebook

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Hospitals Responsible For Large Share Of Growth In Healthcare Prices, Analysis Indicates

Modern HealthcareShare to FacebookShare to Twitter (4/13, Bannow, Subscription Publication) reported that the Health Care Price Index increased “by 2.2% last month year-over-year. Hospitals represent more than 30% of total health spending, and that sector’s price growth of 3.7% last month was barely changed from February, a month that marked a more than eight-year high.” The author of the analysis said it remains unclear “exactly what’s behind the growing rate of hospital prices, but it could be hospitals driving harder negotiations during a period where things generally seem to be going well.”

Source: Modern Healthcare

Kaiser Health News: Federal Officials Say No-Go To Lifetime Limits On Medicaid
The Trump administration’s promise of unprecedented flexibility to states in running their Medicaid programs hit its limit Monday. The Centers for Medicare & Medicaid Services rejected a proposal from Kansas to place a three-year lifetime cap on some adult Medicaid enrollees. Since Medicaid began in 1965, no state has restricted how long beneficiaries could remain in the entitlement program. (Galewitz, 5/7)

Source: Kaiser

The Associated Press: Trump Proposing Billions In Spending Cuts To Congress
The White House said it is sending the so-called rescissions package to lawmakers Tuesday. Administration officials, who required anonymity because they weren't authorized to speak publicly on the matter, said the package proposes killing $15 billion in unused funds. A senior official said about $7 billion would come from the Children's Health Insurance Program, or CHIP, which provides health care to kids from low-income families, though that official stressed the cuts won't have a practical impact on the popular program. (5/7)

Source: The Associated Press

Bloomberg: Drug Plans Drop After Trump Official Targets PBMs Ahead Of Speech
Shares of CVS Health Corp. and Express Scripts Holding Co. slipped Monday after one of the Trump administration’s top health-care officials said the companies’ roles as intermediaries between drugmakers and health plans was hurting patients. Known as pharmacy-benefit managers, or PBMs, the plans negotiate with drugmakers to put their products on lists of covered drugs in return for discounts, and steer patients toward options that they say save them and employers money. Those dual roles are in conflict, said Seema Verma, administrator of the Centers for Medicare and Medicaid Services. (Flanagan, 5/7)

Source: Bloomberg

The Washington Post: CareFirst BlueCross BlueShield And Other Maryland Insurers Seek 30 Percent Premium Hikes For 2019
Insurers are proposing double-digit premium increases in Maryland's individual-health-plan market, a consequence of what the state’s health insurance commissioner called a “death spiral. ”CareFirst BlueCross BlueShield requested an 18.5 percent increase on the HMO plans used by the vast majority of its individual-plan members — and a whopping, 91.4 percent increase on its PPO plans. Kaiser Permanente requested a 37.4 percent increase on its HMO plans. The average rate increase requested, across insurers and plans, was 30 percent. (Johnson, 5/7)

Source: The Washington Post

The Hill: Walmart To Restrict Opioid Prescriptions At Its Pharmacies
Walmart pharmacies will soon limit the supply of first-time opioid prescriptions for acute pain to seven days, an effort aimed at clamping down on an epidemic killing more people per year than car crashes. The initiative will start within 60 days, the company announced Monday, and comes as an increasing number of states and entities in the health-care industry have placed limits on opioid prescriptions. (Roubein, 5/7)

Source: The Hill

The New York Times: Romaine Riddle: Why The E. Coli Outbreak Eludes Food Investigators
Scientists searching for a toxic strain of E. coli that has raced across 25 states, sickening 121 people and killing one, have been able to identify the general source as the Yuma, Ariz., growing region. But as the outbreak enters its second month, they still cannot find the contamination itself — it could be lurking in the area’s fields, water sources, harvesting equipment, processing plants or distribution centers. Federal officials predict that the outbreak, linked to romaine lettuce, will continue for several weeks. (Hoffman, 5/7)

Source: The NY Times

The Washington Post: ‘I Will Sign Immediately,’ Trump Promises On Proposal To Expand Private Health Care For Veterans
President Trump on Thursday promised he would “immediately” sign revamped legislation expanding veterans’ access to private medical care at taxpayer expense, if Congress passes a new plan being considered just weeks before the “Choice Program” runs out of money. In a tweet Thursday, the president noted that it has been four years since the wait-times scandal at a Veterans Affairs hospital in Phoenix. That controversy showed that hospital employees were lying about the amount of time veterans waited for urgent health care, including cancer treatment and mental-health counseling. (Wax-Thibodeaux, 5/3)

Source: Bloomberg

Bloomberg: CVS ‘Moving Forward’ With Aetna Deal, Profit Tops Estimates 
CVS Health Corp. said it’s making “good progress” on getting regulatory approval for its $68 billion deal to buy health insurer Aetna Inc. -- one of two megamergers in the health-care industry that are under antitrust scrutiny. In the meantime, the drug retail giant has suspended its share buyback plan. The company, one of the U.S.’s leading providers of drug-benefits for employers and health plans, also signaled that some employers may be waiting to see how the sector will be reshaped before making major decisions on contracts that typically last three years. (Langreth, 5/2)

Source: Bloomberg

The Hill: Price Walks Back Warning On ObamaCare Individual Mandate
Former Health and Human Services Secretary Tom Price on Wednesday walked back comments he made predicting repealing ObamaCare’s individual mandate would drive up insurance costs. In a statement, Price said his remarks at Tuesday’s World Health Care Congress were taken out of context. (Weixel, 5/2)

Source: The Hill

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