October 11, 2017
Iowa awaits ruling on request to leave the ACA market
If approved, an innovation waiver filed with CMS by the state of Iowa would allow the state to disband key components of the ACA. The pending waiver would let Iowa establish a reinsurance program, disband the state’s insurance marketplace and reallocate the way subsidies are distributed. Critics claim the proposal fails to meet legal requirements for innovation waivers, as the plan would lead to premium and deductible increases and potentially reductions in coverage. It’s unclear if the Trump Administration will approve the waiver, but there are reports that President Trump instructed CMS Administrator Seema Verma to decline the waiver request. If the request is approved, other states could model their own waivers on Iowa’s.
Delayed vote for CHIP funding bill
Republican lawmakers on a key House committee have agreed to resume negotiations with Democrats over funding for CHIP. The committee had previously approved a bill that funded CHIP by taking funds from Medicare and ACA programs to offset costs. Although Democrats and Republicans are discussing a bipartisan approach, Rep. Greg Walden (R-OR) noted that the existing legislation will be put up for a vote after next week’s recess if no new deal is reached by then. In addition, the Senate Finance Committee passed a bipartisan five-year reauthorization of the program last week but has not yet said how it would pay for the measure.
Trade groups call into question Allergan’s patent deal
ACHP joined a coalition of 10 groups including hospitals, health plans and generic drugmakers in sending a letter to Congressional leaders Tuesday asking them to examine Allergan’s controversial patent deal with a Native American tribe. The letter came after at least nine Members of Congress raised objections to the deal, in which Allergan transferred patents from its $1.4 billion eye drug Restasis to the Saint Regis Mohawk Tribe, whose sovereign immunity could shield it from certain patent challenges from generic drugmakers.
Obstacle to telehealth
Reimbursement was most frequently cited as an obstacle to telehealth in a new survey of the 114 chief information officers, IT directors, telehealth managers, and others by the College of Healthcare Information Management Executives and KLAS. In the survey, 59 percent of respondents said reimbursement was problematic, followed by cost and resources at 34 percent and patient and provider awareness and education at 25 percent. Congress is considering legislation that would expand reimbursement for telehealth visits and the survey’s authors believe the care model will be increasingly adopted in the future. The lack of reimbursement has made it difficult for organizations to make the business case for expanding telehealth.
New acting Health Secretary
President Trump announced Eric Hargan will serve as acting secretary for the Department of Health and Human Services. Hargan was confirmed by the Senate last week to fill the No.2 position within HHS. Hargan was previously a Chicago-based lawyer and served at HHS in the Bush administration, holding various positions such as deputy general counsel, principal associate secretary and acting deputy secretary. Don Wright, Acting Assistant Secretary for Health, had been serving as acting secretary following the resignation of Tom Price. Among the candidates rumored to permanently replace Price are FDA Commissioner Scott Gottlieb, CMS Administrator Seema Verma and former Louisiana Governor Bobby Jindal.
Cleveland clinic expands role in insurance market
Cleveland Clinic has announced a partnership with Humana to create two $0 premium Medicare Advantage health plans in Cuyahoga County, Ohio. This is the health system’s second co-branded insurance product
in recent months. In June, the clinic announced it was making its first entrance into the insurance market with a product bearing its name in collaboration with New York City-based Oscar Health. Clinic officials say that the current health insurance strategy is designed to improve health care outcomes, lower costs and enhance patient experiences. Both partnerships offer narrow-network products, meaning the plans don’t include the entire market of providers and facilities, but rather Cleveland Clinic doctors and hospitals.
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