Daily on Healthcare: Shorter Obamacare enrollment period: sabotage or savior?

By | December 11, 2018

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Shorter Obamacare enrollment period: sabotage or savior? Democrats and Obamacare’s defenders often list the shortening of the open enrollment period as one of the many acts of sabotage they believe the Trump administration has committed against the healthcare law, but it’s not clear that giving people less time to pick out a health plan hurts the market. Under President Trump, Obamacare customers have just six weeks to pick out health insurance. That’s half the amount of time they had under former President Barack Obama, whose administration at the tail end of open enrollment also would permit grace periods from two to four days. Yet, despite the changes that the Trump administration has made and Democrats have decried, premiums have gone down slightly heading into 2019, helped along by federal dollars in the form of reinsurance programs, and more insurers are offering coverage. Enrollment, too, could hold up.

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Big Pharma’s biggest threat in Washington? It may be this obscure research firm. The U.S. pharmaceutical industry’s greatest worry in Washington, D.C., might not be Trump’s drug-pricing blueprint or Democrats’ retaking control of the U.S. House of Representatives, but a little-known, non-partisan research firm. The Institute for Clinical and Economic Review, or ICER, evaluates prescription drugs to determine whether list prices align with the clinical and economic value for patients. Its reports take into account factors such as how many years of life a treatment can add, how quickly it can return someone to work and whether the regimen is easier for patients than a competitor’s product. While the group validated the list price of seven of the 11 treatments it analyzed this year, it often rates a particular drug as more expensive than its actual value to patients. Unsurprisingly, such reports have driven intense opposition from the pharmaceutical lobby, which sees the research as too similar to the cost-effectiveness evaluations used by European healthcare regulators like the National Institute for Health and Care Excellence, or NICE, a group that effectively sets the price that the U.K. government will pay for a medication.

Brazen fentanyl sales continue online as China vows crackdown. Trump left dinner with Chinese President Xi Jinping confident thousands of American lives could be saved: the president announced Xi would introduce the death penalty for illegally dealing fentanyl, a synthetic and deadly opioid. “What he will be doing to fentanyl could be a game changer for the United States,” Trump said on Air Force One as he returned from the G-20 summit in Argentina. Although Chinese-made fentanyl is reputed to have flooded the U.S. market — cheaply adding a respiration-arresting kick to unwitting buyers of heroin and knock-off pills — experts are far more cautious.

Trump administration aims to develop replacements for fetal tissue in research. The National Institutes of Health will be providing grants that encourage the use of new types of tissue that would replace fetal tissue in medical research. “The program aims to develop and/or further refine human tissue models that closely mimic and can be used to reliably model human embryonic development or other aspects of human biology, for example, the human immune system,” the NIH said in a statement. “Research proposals may include using these models to understand human tissue development, function, and disease.” The announcement from the government’s medical research branch comes amid a debate over whether to end all funding for fetal tissue research. Much of the tissue is obtained from abortions, and anti-abortion groups have been pressuring the administration to drop all funding on the matter. Researchers who use the tissue have argued that it is vital for developing treatments or cures to conditions such as HIV and Parkinson’s disease.

The latest announcement is part of an ongoing debate on fetal tissue. Trump administration officials have been meeting with medical groups, ethicists, and anti-abortion advocates in recent weeks to determine what to do about the research, and the administration announced in September that it was conducting an audit across all of its health agencies to make sure that all regulatory, ethical, and moral guidelines were being met. The announcement followed a decision by the Department of Health and Human Services, the NIH’s parent agency, to end a contract with Advanced Bioscience Resources, Inc., saying the contract didn’t have appropriate protections in place. Last week the Washington Post published a story saying that the Trump administration planned to end another contract at the University of California at San Francisco, where fetal tissue was implanted into mice to conduct research on HIV. The Trump administration called the story “completely false,” saying a decision on the contract hasn’t been made yet. Science Magazine also reported that the NIH had ordered its scientists to stop acquiring new human fetal tissue for experiments. These scientists are directly employed by the agency, rather than outside universities or organizations receiving grants from NIH. The NIH estimates that roughly $ 98 million was spent in 2017 on research involving fetal tissue.

Republicans introduce new version of end-of-year tax bill with an eye toward speedy passage. House Republicans introduced new end-of-year tax legislation Monday that includes the delay Obamacare-related taxes. The bill would delay several Obamacare taxes that have previously been postponed, thanks to opposition from both parties. It would delay Obamacare’s implementation of the medical device tax, a 2.3 percent tax on the industry, until 2025. Currently it is set to go into effect in 2020. It would also suspend the “Cadillac tax” on high-cost health insurance plans through 2022, moving the date it was supposed to take effect back by another year. Another tax on health insurance would be delayed by another two years, until 2022. The GOP bill would also repeal a tax on tanning salons. Republicans need several Democrats to support the bill in order to meet the 60 vote threshold to advance legislation and avoid a filibuster in the Senate. Congressional leaders may end up adding the tax bill to either end-of-year government funding legislation, or to another in their laundry list of must-pass items in order to expedite passage.

Anti-abortion groups disappointed by Supreme Court’s decision on Planned Parenthood.  Newly confirmed conservative Justice Brett Kavanaugh dealt a blow to anti-abortion advocates Monday in declining to hear a case that could have resulted in government funds being stripped from Planned Parenthood. But advocates refrained from singling Kavanaugh out over the decision, instead saying that despite their disappointment over the decision they aim to use other means to cut off government funds from Planned Parenthood. The Supreme Court’s decision not to take up the case leaves intact lower court decisions that allowed Planned Parenthood to continue to receive Medicaid funding in Kansas and Louisiana, where lawmakers had sought to undo it. The decision over whether to take up the case fell short by one vote; four justices must agree to hear a case in order for it to receive a day before the high court. Kavanaugh, in his first major decision related to the issue of abortion, sided with three liberal justices and Chief Justice John Roberts. “Some of us told you he’d be another Roberts,” Phil Kerpen, president of the conservative group American Commitment, tweeted about Kavanaugh.

Anti-abortion groups said the case went beyond abortion. Most anti-abortion organizations agreed with the point made by Justice Clarence Thomas in his dissent, that the case would have raised important constitutional issues and shouldn’t be dismissed just because it concerned the controversial topic of abortion. The issue in question was whether patients on Medicaid who received medical care from places such as Planned Parenthood have the right to challenge a state’s decision to cut off funding from the organization. Lower courts have been split on such a question, and Louisiana and Kansas asked for a resolution. Justices Samuel Alito and Neil Gorsuch sided with Thomas in saying they believed the case should be heard.

Thomas in his dissent accused the other justices of avoiding the case because the issue of abortion was at play, saying the question at the heart of the case was more broad. “He really did pretty much lay it out there saying that the court is refusing to answer this question that is tangentially related to abortion because it has become such a toxic issue,” said Melanie Israel, research associate in the DeVos Center for Religion and Civil Society at the Heritage Foundation.

Survey: Short-term plan customers cite price as important to their choice. That’s according to a survey from eHealth, which found 86 percent of shoppers on its site who picked short-term plans did so because it saved them money. Among people who selected Obamacare plans, 62 percent said they did so because it saved them money, and 46 percent said they covered the benefits they valued most. In contrast, 24 percent of short-term plan buyers said the plans had the benefits they valued. Thirty-eight percent of people who bought a short-term plan for 2019 said they had first considered getting a plan on the exchange. The survey used interviews from 726 people buying Affordable Care Act coverage and short-term health insurance through eHealth during this open enrollment.

FDA approves app to treat opioid addiction. The mobile app, called reSET-O, is supposed to increase the amount of time a patient spends in an outpatient treatment program for opioid addiction. The app is supposed to be used under medical supervision and when a patient is taking buprenorphine, which staves off withdrawal symptoms, as well as using “contingency management,” a type of treatment in which someone is directed toward a new type of behavior. The app gives people badges and other rewards when they meet certain goals. “Often on the road to recovery, patients find their commitment to staying in treatment may wane,” FDA Commissioner Scott Gottlieb said in a statement. “Providing Americans suffering from opioid use disorder with more options and proper support to address treatment challenges is key to helping them succeed.”

Hospitals blame insurers for surprise medical bills. Earlier in the day on Monday a health coalition that included insurers blamed doctors and hospitals for surprise medical bills, and said they supported legislation that would not result in patients paying for the bills and that would obligate providers to tell patients they weren’t in network. The American Hospital Association and the Federation of American Hospitals struck back later on Monday, saying that “inadequate health plan provider networks” were the “root cause” of surprise medical bills. The organizations said they supported protections on patients but didn’t endorse passing legislation.

Hospitals oppose ‘public charge’ immigration proposal. Richard Pollack, president and CEO of the American Hospital Association, said the proposal on immigration was “contrary to this hospital mission of service to the most vulnerable” and “could put coverage at risk for millions.” The group asked for the proposal to be withdrawn immediately. The Trump administration’s proposal is to change a public rule to potentially favor legal immigrants in the United States who are applying for green cards and those applying to enter the country on visas who have not used or do not have plans to use public benefits, including Medicaid, food stamps, and public housing.

House Democrats oppose the proposal. Rep. Frank Pallone, Jr., the top Democrat on the Energy and Commerce Committee, and Rep. Richard Neal, the top Democrat on the Ways and Means Committee said in a letter to Department of Homeland Security Secretary Kirstjen Nielsen Monday that they were concerned about proposed changes to the public charge test, urging her to withdraw the idea.  “If finalized, the rule would directly and indirectly exacerbate and undermine participation in public programs that support work, strengthen families, and provide basic necessities to children that are critical in their development to become strong, productive adults,” they wrote.  “It would do this through the threat — both real and perceived — that seeking benefits could affect immigration status or entry into the United States. This would increase hunger and food insecurity and could force older adults and their families to forgo needed healthcare and services.”

Judge presses opponents of Trump transgender ban on ‘who is combat ready.’ The legal saga surrounding Trump’s order to restrict transgender military service took another turn Monday as federal judges lobbed tough questions at opponents in a D.C. courtroom. The panel of judges on the D.C. Circuit Court of Appeals wanted to know why the judiciary should be involved in deciding who is combat ready and why banning troops who have undergone gender transition surgery is discriminatory. The oral arguments were part of the Justice Department’s effort to lift one of four court injunctions that have blocked the Trump administration from imposing its new policy barring enlistment for anyone who has undergone gender reassignment surgery or been diagnosed with gender dysphoria.

Opinion: Eating raw cookie dough is probably worth the risk. The Centers for Disease Control and Prevention is out with a warning that nobody who likes to eat delicious things wants to read: ” Say No to Raw Dough!” But the truth is that eating raw cookie dough is probably worth the risk for most people. In a special page dedicated to the issue, CDC ominously cautions, “When you prepare homemade cookie dough, cake mixes, or even bread, you may be tempted to taste a bite before it is fully cooked. But steer clear of this temptation — eating or tasting unbaked products that are intended to be cooked, such as dough or batter, can make you sick.”

The CDC goes on to explain that uncooked flour could contain e coli bacteria and that raw eggs pose a risk of getting sick from salmonella. On the surface, those sound pretty bad. That said, it’s important to put things in perspective. Sure, eating cookie dough can make you sick — but it probably won’t.

Opinion: Employer mandate would not solve the financing dilemma for backers of socialized medicine. Proponents of socialized medicine who are pushing to extend Medicare to everybody have a real problem when it comes to figuring out a way to pay for its estimated $ 32 trillion cost without causing massive disruption. But one idea being floated — mandating that all employers pay for their workers to be enrolled in Medicare — is not a realistic solution.

RUNDOWN

The Hill Oklahoma seeks Trump approval on Medicaid work requirements

USA Today Only abortion provider left in Tennessee’s capital suspends abortion services

Fierce Healthcare Olympus to pay $ 85M after pleading guilty to fraudulently selling scope linked to superbug spread

Philadelphia Inquirer Prescriptions — and overdoses — are skyrocketing for anti-anxiety drugs that make opioids even more lethal
The Associated Press Record count reported for mysterious paralyzing illness

Science Dog research at U.S. Department of Veterans Affairs gets formal review

Modern Healthcare Congress to pass children’s health home legislation by year-end

TUESDAY | Dec. 11

House and Senate in session.

Dec. 10-11. Ritz-Carlton. Health Law Summit. Schedule.

Dec. 10-12. Washington Hilton. Community Integrated Health Conference. Details.

2:30 p.m.1225 I St. NW. Bipartisan Policy Center event on “Financing the Public Health Infrastructure.” Details.

WEDNESDAY | Dec. 12

7:30 a.m. AJAX. Axios event on “Healthcare in 2019.” Details.

10 a.m. 1333 H St. NW. Center for American Progress event with Sen. Kamala Harris, D-Calif., on “Women of Color Experts to Discuss Eliminating Racial Disparities in Maternal and Infant Mortality.” Details.

THURSDAY | Dec. 13

Dec. 13-14. 31 Center Drive, Bethesda, Md. National Institutes of Health advisory committee meeting. Details.

Dec. 13-14. 1300 Pennsylvania Ave. NW. Medicaid and CHIP Payment and Access Commission meeting. Details.

Dec. 13-15. Las Vegas. Annual World Congress. Schedule.

10 a.m. 2154 Rayburn. Subcommittee on Healthcare, Benefits, and Administrative Rules and Subcommittee on Government Operations joint hearing on “Exploring Alternatives to Fetal Tissue Research.” Details.

SATURDAY | Dec. 15

End of healthcare.gov open enrollment.

Healthcare

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