ACHP Media Monitoring Report – December 6, 2017


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December 6, 2017

The fate of the individual mandate
Republicans in the House continue to push for the repeal of the individual mandate to be included in the final tax bill. In a letter to Ways and Means Committee Chairman Kevin Brady (R-TX) and Senate Finance Committee Chairman Orrin Hatch (R-UT), several House republicans asked that the provision be included in final tax legislation. The House-passed tax bill did not include repeal of the mandate, while the Senate bill did. The two chambers are now reconciling their versions of tax-reform legislation.Some key GOP centrists supported a Senate tax overhaul that repeals the individual mandate, a move experts say will likely drive up premiums, on the condition that it be swiftly accompanied by the Alexander-Murray bipartisan measure that aims to lower premiums. The measure goes hand-in-hand with legislation from Sens. Susan Collins (R-ME) and Bill Nelson (D-FL) that would give almost $10 billion to states over two years for programs designed to reduce premium costs. Some lawmakers and health experts say these steps are necessary to offset the damages of repealing the insurance mandate. However, there is no guarantee these measures will pass, as lawmakers continue to be divided on support for the bills. According to the nonpartisan CBO, repeal of the individual mandate could cause premiums to increase by 10 percent a year for the next decade.

Insurers post profits off ACA plans
A Politico analysis of 31 regional Blue Cross Blue Shield health plans found that, for the first time, many insurers profited off the ACA’s individual market in 2017. Insurers only spent 78 percent of premium revenue on medical claims, a huge drop from last year when, according to Standard & Poor’s, insurers spent 90 percent, a shift largely attributable to higher premiums. The analysis suggests insurers have finally established appropriate models for participating in the exchanges. Although health plans are finally seeing success in the individual market, experts point out the market is still fragile due to low exchange participation and an unclear political landscape.

CMS takes new approach to push value-based care
Industry groups believe the government is likely to take a conservative approach as it moves toward value-based care. Hospital and doctor trade groups have interpreted recent government actions as a sign the Administration intends to end mandatory bundled payment initiatives, but is not abandoning the shift all together. CMS on Thursday officially removed mandatory hip fracture and cardiac bundled payment programs and scaled back the mandatory Comprehensive Care for Joint Replacement Model. Providers expect a new approach to bundled payments that focuses on more flexibility and fewer regulations.Medicare policy has hospitals and trade groups at odds
The Medicare Payment Advisory Commission (MedPAC) released a report finding hospitals and their trade groups disagree on a rule that requires a physician to aid and direct other hospital staff on certain procedures. The 21st Century Cures Act required MedPAC to examine the impact of the direct-supervision requirement, a rule that was introduced in 2009 but has yet to be enforced. Hospital representatives said they have trained staff to adjust to the rule, while the American Hospital Association believes the policy as a whole is burdensome to its members and supports a permanent repeal. CMS will not enforce the policy in 2018 and 2019, saying there was not an effective way to monitor the requirement, as Medicare would likely learn about policy breaches through a whistle-blower.

UnitedHealth acquires DaVita Medical Group
UnitedHealth acquired the DaVita Medical Group’s kidney dialysis firm Davita in a $4.9 billion deal on Wednesday. DaVita Medical Group operates nearly 300 clinics and a half dozen outpatient surgical centers in six states. The DaVita facilities will become part of United’s Optum division, the umbrella for the noninsurance side of the business including pharmacy benefits, data analytics, consulting, clinics and surgical centers and home care. The DaVita deal marks Optum’s fourth and largest transaction this year.

Washington D.C. protects women’s health benefits
On Tuesday, the D.C. Council voted overwhelmingly to block local insurance providers from charging additional fees for preventive women’s health services. The legislation required insurance providers to offer contraception, breast cancer screening and counseling for sexually transmitted infections without raising co-pays or deductibles. These benefits are required by ACA guidelines but are not written into the text of the law. The move comes in anticipation of the possible repeal of the ACA and regulatory rollbacks.

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