Healthcare Loses 44,000 Jobs During Q1 2021, While Spending, Prices Continue To Grow

Healthcare loses 44,000 jobs during Q1 2021, while spending, prices continue  to grow - nativenewspostSource: Fierce Healthcare, by Dave Muoio

Employment in the U.S. healthcare industry has dropped by 44,000 jobs over the course of the first quarter of 2021, according to reports from nonprofit healthcare research and consulting group Altarum.

These job losses came alongside continued spending growth recovery and increases in overall healthcare prices.

Modest employment gains in February and March were unable to offset January’s substantial decline of 80,000 healthcare jobs.

Many of these losses were felt among hospitals, which lost 37,000 jobs in the first quarter, and nursing and residential care, which dropped 38,000 jobs. On the other hand, ambulatory care settings picked up 37,000 new jobs in the first three months of the year.

Overall, the healthcare industry has lost a total of 557,000 jobs since February 2020’s pre-COVID-19 peak, a 3.1% decline. This number represents 7% of the total economy’s 8.4 million lost jobs, which Altarum noted was not the case during other recent recessions.

“The declines in employment in parts of health care in 2021 are noteworthy given how consistently health sector jobs grew prior to 2020,” the organization wrote. “Of course, with 15.9 million jobs in healthcare, 44,000 jobs lost in Q1 2021 represents a decline of only one-third of 1%.”

National health spending has worked its way back from a major fall during the spring and early summer of 2020, the organization wrote.

In February, the industry hit the same $3.9 trillion in total spend it’d reached in a year prior. Year-over-year growth has averaged a hair above 0% since July 2020; however, spending growth from August through February was 3.5%, on par with the 3.4% growth seen during the same period last year.

“Because spending was growing in the year before the start of the pandemic, the near-zero year-over-year growth rates in recent months indicate that recent spending growth has been similar to pre-pandemic rates,” Altarum wrote.

Healthcare prices continue the pandemic trend of higher-than-usual increases, the organization noted. The Health Care Price Index rose 2.5% year over year in March, slightly slower than February’s 2.6% annual growth.

The increases were led by hospital care price growth of 4.8% year over year­—the fastest growth Altarum said it’s seen among hospitals since June 2004. On the other hand, retail prescription drugs saw their sixth straight month of price declines, recording a 2.3% year-over-year drop in March. These were joined by durable medical equipment (-2.4%) and other nondurable medical products (-2.1%).

Altarum framed healthcare’s price increases alongside similar price acceleration across the broader economy. It said that macro trends such as federal stimulus funds, lifting state economic restrictions and COVID-19 vaccinations “may be expected to continue into the summer and provide a tailwind for higher health sector prices in the near future.”

Altarum’s reports coincide with others that suggest physicians’ full-time salaries are beginning to rebound in the wake of substantial pandemic volatilities that included fewer hours or complete halts in monthly income.

Deloitte recently predicted healthcare spending to hit $8.3 trillion by 2040. The consulting firm’s long-term outlook was well below the federal government’s estimate, a discrepancy Deloitte attributed to earlier disease detection and the increasing role of the consumer in seeking appropriate care.

CMS Finalizes Drug Transparency, Pharmacy Quality Rules

CMS finalizes drug transparency, pharmacy quality rules

Source: Fyne Fettle, by James Schneider

CMS on Friday finalized a rule it estimates will save the federal government $75.4 million over the next decade in Medicare Advantage and Part D payments, with the agency crediting cost-savings to several measures enacted to curb prescription drug spending.

Under the new rule, CMS expanded drug and medication therapy management programs that require Medicare Part D plans to review potentially-risky opioid use trends with providers and patients. The final law also requires Medicare Part D sponsors to report payment suspensions against pharmacies facing fraud allegations to CMS, falling in line with the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT Act. The legislation also mandated Medicare Advantage and Part D plan sponsors report inappropriate opioid prescriptions and insurers’ actions to CMS via a secure internet portal.

In addition to cracking down on providers’ opioid prescriptions, the new rule includes steps to reduce out-of-pocket drug costs for Part D beneficiaries, standardize insurers’ process for reviewing pharmacy quality and allow enrollees to know more about their prescription drug costs in advance. The new rule follows an earlier set of Medicare Advantage and Part D updates CMS made in May 2020.

CMS will now require insurers to tell the agency how they calculate pharmacy performance measures by January 1, 2022, after complaints from the pharmaceutical industry the criteria used were unfair. CMS will publicly report the metrics to help insurers standardize the process for reviewing pharmacy performance, the agency said.

The federal agency will also give Part D plans the ability to create a “preferred” specialty tier of high-cost drugs with lower cost-sharing for enrollees by January 1, 2022. That change could help negotiate lower prices for expensive medications with drugmakers by promising them access to the so-called preferred tier.

Continuing the Trump administration’s efforts to reduce healthcare spending through increased transparency and lower drug costs, CMS wants Part D prescription drug plans to offer beneficiaries access to patient-specific drug costs in real-time by January 1, 2023. As an example, CMS said this tool will allow consumers to compare the price of similar, cholesterol-lowering drugs to see which requires the lowest individual copay. The final rule pushes this requirement back a year from its initial proposal.

“The changes in this final rule provide desperately needed transparency on the out-of-pocket costs for prescription drugs that have been obscured for seniors,” CMS Administrator Seema Verma said in a statement. “It will strengthen Part D plans’ negotiating power with prescription drug manufacturers so American patients can get a better deal.”

The final rule also updates Star Ratings and Quality Bonus Payment ratings, although CMS did not give details on the specific changes. The agency added that it is also working to codify policy changes related to supplemental benefits and provisions aimed at reducing the administrative burden for Programs of All-Inclusive Care for the Elderly, or PACE.

Retired Doctors And More Syringes: Biden Lays Out Plan To Get America Vaccinated

Retired doctors and more syringes: Biden lays out plan to get America  vaccinated | Reuters

Source: Reuters, by Trevor Hunnicutt

U.S. President-elect Joe Biden on Friday said he would order increased production of syringes and other supplies to ramp up vaccinations against COVID-19 and improve upon the Trump administration rollout that he called a “dismal failure.”

Under Biden’s plan, federal disaster-relief workers would set up thousands of vaccination centers, where retired doctors would administer shots to teachers, grocery store workers, people over 65 years old and other groups who do not currently qualify.

The Democrat would invoke the Defense Production Act to increase production of equipment needed to distribute the vaccines, such as glass vials, needles and syringes, according to a document released by his transition team. He would also use the law to support vaccine refrigeration and storage.

Biden said his team has identified companies that are ready to be activated under the law, which enables the president to order businesses to produce items necessary for national defense.

States that use their National Guard in the effort would be reimbursed by the federal government, the transition team said.

The coronavirus has killed more than 390,000 people in the United States, and a top Biden adviser said on Friday the death tally could reach 500,000 by February.

Biden has promised to do better than President Donald Trump to curb the virus and get 100 million vaccine shots into the arms of Americans during his first 100 days in office.

“This is a time to set big goals and pursue them with courage and conviction because the health of the nation is literally at stake,” said Biden, who takes office on Wednesday.


Speaking near his home in Wilmington, Delaware, Biden called for increasing vaccine distribution in lower-income neighborhoods not currently well served by hospitals and pharmacies. Biden also plans a marketing campaign to encourage those skeptical of the vaccine to get inoculated.

His transition team said he will reorganize the vaccine distribution team currently called “Operation Warp Speed” and has asked former Food and Drug Administration chief David Kessler to work with manufacturers to boost vaccine availability.

Biden said his administration will release the vast majority of doses when they become available, rather than holding back a large portion to ensure that recipients can get a second dose, which had been the Trump administration’s approach for much of the rollout. States will get regular updates to know how many doses are coming to ensure they can distribute them efficiently.

He said he will order the Federal Emergency Management Agency to set up 100 vaccine centers within a month, which he said would ultimately serve millions of people. Neighborhood pharmacies would also be enlisted as vaccination sites, he said.

Even with these changes, Biden said it will take time for the United States to beat back the virus. “The honest truth is this: things will get worse before they get better,” he said.

Biden unveiled a $1.9 trillion stimulus plan on Thursday that includes $20 billion for vaccine distribution as well as $50 billion for coronavirus testing, which experts and officials said should help speed the process up.

The stimulus proposal faces an uphill battle in Congress, however. When Biden takes office, Democrats will control both the Senate and the House of Representatives but by narrow margins. Some Republicans have balked at its cost, while liberals have pushed for more spending on direct payments to individuals.

The Trump administration had aimed to give vaccine doses to 20 million Americans by the end of 2020. But only 12.3 million coronavirus shots had been administered as of Friday morning out of more than 31 million doses distributed to states, according to data from the U.S. Centers for Disease Control and Prevention.

Federal officials have largely left states to manage distribution, resulting in big differences in vaccination rates. The Trump administration has said it expects 1 million shots to be delivered per day by the end of next week.

A Trump administration official, speaking on condition of anonymity, said the United States is on track to have 300 million doses available by the end of Biden’s first 100 days in office.

California Hospitals Prepping For Grim COVID-19 Choices

Source: Modern Healthcare

California hospitals struggling with a skyrocketing coronavirus surge are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don’t have to make that choice.

The state avoided surging cases for months, but now the virus is raging out of control there and across the nation in the wake of Thanksgiving holiday gatherings that authorities say vastly spread infections. Only Arizona tops California in cases per resident.

The state this week ordered hospitals in the hardest-hit areas to delay many elective surgeries in order to free up space.

In Los Angeles County, Methodist Hospital of Southern California convened an in-house triage team that makes daily evaluations “about the severity of critically ill patients that allows us to distribute resources to those who need it the most,” chief strategy officer Cliff Daniels said.

The hospital isn’t rationing care “and we hope we don’t get there,” Daniels said.

However, guidelines posted on the hospital’s website warn: “If a patient becomes extremely ill and very unlikely to survive their illness (even with life-saving treatment), then certain resources … may be allocated to another patient who is more likely to survive.”

Los Angeles County, the nation’s most populous with 10 million residents, is one of nearly two dozen in Southern California and the agricultural Central Valley that have essentially run out of intensive care unit beds for COVID-19 patients.

Health officials warned Wednesday that hospitalizations will continue for at least the next three weeks as people who ignored social distancing rules to gather for Christmas and New Year’s Eve fall ill.

Hospitals statewide with room have been told to accept patients from others that have exhausted their ICU beds but in fact most of the state is reporting struggling to provide ICU beds, with non-COVID-19 patients spilling into corridors, tents and cafeterias.

To the north, officials in Santa Clara County, with about 2 million residents, say 100 infected people a day are winding up in hospitals.

“And as awful as it is, it could get worse,” said Dr. Ahmad Kamal, the county’s director of Healthcare System Preparedness. “We haven’t had a situation where two people are out of breath and one person gets a ventilator. We could get there.”

California reported its second-highest number of daily coronavirus deaths Wednesday with 459 lives lost, bringing the death toll to 2,504 in the last week as more than a quarter-million new weekly cases portended a continued overwhelming crush.

Vaccinations being administered at what Gov. Gavin Newsom has said is too slow a pace will take weeks or months to slow the spread.

About 12% of people who test positive for COVID-19 eventually are likely to need hospital care, authorities have estimated.

“The numbers are extraordinary,” said Carmela Coyle, president and CEO of the California Hospital Association. “We’re not going to dodge this math. We need the state’s help.”

State officials also should override decisions by many county health officers that prevent recovering coronavirus patients from being released to skilled nursing facilities, despite fears that they could spread the virus, Coyle said.

“Focus on nothing other than saving lives for the next few weeks,” Coyle said.

L.A. County, which is recording more than 200 deaths a day, has seen a rate of new COVID-19 cases nearly double that of December, health officials said.

More than 8,000 people are hospitalized with COVID-19 — with a fifth of them in intensive care — and more than a third of adult hospital beds are occupied by virus patients, said Barbara Ferrer, the county public health director.

“This is a health crisis of epic proportions,” Ferrer said.

Surprise Medical Billing Fix Included On COVID Relief Bill

Medical bill

Source: BenefitsPRO, by Alan Goforth

A long-discussed surprise medical billing fix will be part of the congressional budget deal that includes $900 billion in new COVID-19 relief.

“This is terrific news,” said Kim Buckley, vice president of client services for DirectPath. “Previously, there was a patchwork of 31 state-based programs that had attempted to address this issue, with some states taking a more comprehensive approach than others. And these programs only affected fully insured plans in that state and could not address air ambulances, a major source of surprise bills. The new federal legislation will apply a consistent approach to all plans, both self- and fully insured, and extend to those states who have not yet offered consumer protections against surprise bills.”

Though key congressional committees had agreed more than a week ago on a plan for protecting insured patients from large medical bills when they unwittingly receive out-of-network care, it had been unclear whether it would be part of must-pass government funding legislation, ”Politico” reported. The final decision came down to Senate Majority Leader Mitch McConnell, who had been silent on the deal.

The White House already has endorsed the plan nearly two years after President Donald Trump first called on Congress to fix an issue that has drawn bipartisan concern. But those efforts were nearly derailed by opposition from well-funded groups and congressional turf battles. While the health care industry agreed that patients should be held harmless in emergency situations, hospital and physician groups and insurers fought vigorously over who would pick up the tab. The compromise deal congressional committees struck earlier this month was considered largely a win for hospitals and doctors, and tweaks made in the final legislation are even friendlier to providers.

The previously announced deal called for health insurers and providers to negotiate most billing disputes or bring their complaints to a mediator. But in one key change, the final version of the bill would forbid arbiters from taking into account Medicare and Medicaid rates, which typically are much lower than what commercial coverage pays. That is a loss for insurers, employers who fund a major chunk of private coverage, and patient advocates who thought including those public rates as a barometer could help curb health-care prices. As a guardrail, the measure also bars arbiters from considering providers’ billed charges, which usually are well out of line with what insurers or patients end up paying.

However, in a win for health insurers, lawmakers appear to have watered down a measure that would have required them to disclose detailed information to employers about their drug costs and rebates through their contracts with pharmacy benefit managers, whose business practices have come under scrutiny in recent years for their role in high drug costs. Instead, the legislation calls for insurers to submit more general information on medical costs and prescription drug spending to relevant federal agencies, which would feed into a government report on drug pricing trends.

“It remains to be seen how well the arbitration system will work,” Buckley said, “but this is an important step in the right direction for protecting consumers, including those who did all the right things to ensure their care was in-network but received surprise and balance bills through no fault of their own.”

Some Insurers Move To Stop Waiving Telehealth Copays

Source: STAT, by Rebecca Robbins and Erin Brodwin

Starting Oct. 1, several private health insurers will no longer fully pay for virtual visits under certain circumstances — effectively reinstituting costs for patients reliant on the virtual care that has been heralded as a lifeline at a time when Covid-19 is still killing more than 700 Americans each day.

The insurance giant UnitedHealthcare is ending a “virtual visit” benefit that had been expanded to many members during the Covid-19 pandemic, through which it was covering the full cost of visits — without any cost to patients — for individuals who were seeing in-network providers virtually for medical issues not related to Covid-19. (Asked by STAT for details, a UHC spokesperson pointed to a page on the company’s website.)

And Anthem, the company behind a number of affiliated health plans across the country, will stop waiving the cost of copays, coinsurance, and deductibles for virtual visits not related to Covid-19. Beginning Oct. 1, a commercially insured “member’s cost shares will be applied based on the terms of the plan they purchased,” the spokesperson said, adding that Anthem-affiliated health plans “have a long history of covering telehealth visits.” The spokesperson did not return STAT’s request for details about the coverage changes for different Anthem-affiliated health plans.

As the pandemic gained steam this past spring, both commercial insurers and government payers made rapid changes to the way they covered virtual visits. In many cases, they offered for the first time to pay for telemedicine for certain issues, or to reimburse for it at the same rate as traditional in-person visits. That enabled telemedicine to become a vital resource during the crisis, particularly for the elderly and for people with medical conditions and vulnerable family members who could be put at risk if they were to venture out for an in-person visit to the doctor’s office.

“I think it’s irresponsible to decrease payment for the kind of care that so many patients are receiving. For many patients, it’s their lifeline right now — it’s the only way that they’re feeling comfortable or safe receiving care,” said Adam Licurse, executive director of the virtual care department at Brigham and Women’s Hospital and Faulkner Hospital in Boston.

Licurse, a primary care physician who provides virtual care himself, said the need is especially pronounced in the “many parts of the country that are unfortunately dealing with a lot of higher Covid incidence right now.”

For patients seeking out virtual care, what cost-sharing for an appointment actually means can vary widely from one plan to the next. Depending on the nature of the visit, a telehealth appointment can cost in the ballpark of $100 to $400, and cost-sharing passes some fraction of that down to the patient or their clinic or hospital, which might, in some cases, voluntarily cover all or part of the cost so that the patient doesn’t have to shoulder it.

It’s not clear yet how much patients affected by the changes being implemented this week can expect to have to pay for telehealth visits, nor is it clear how those costs will compare to copays for an in-person visit.

A spokesperson for Anthem declined to provide any numbers when asked by STAT for a rough figure on anticipated fees for patients or costs that might be shouldered by providers helping cover cost-sharing. “It would be misleading to provide a ballpark cost share figure because it not only varies plan by plan, but also member by member depending on whether or not the member has an annual deductible and, if they do, whether or not they have met that deductible,” the spokesperson said.

UHC did not return STAT’s request for the same estimate, but UHC’s website says that patients might generally expect to pay $50 or less for a virtual visit.

Some commercial insurers — including CVS Health and BlueCross BlueShield Tennessee — that had been planning to end their expanded telehealth coverage this week have already extended their Sept. 30 expiration date until the end of this year, and others could still follow suit in the next few days.

When patients learn in advance that their insurer will not cover a telemedicine visit in part or in full, they may proceed in one of several ways: The patient may opt to go through with the virtual appointment anyway. (Depending on its policy and resources, the hospital or clinic may shoulder the remaining cost, or it may require patients to pay all or part of it.) Alternatively, the patient may decide to instead go into the office for a traditional in-person visit, or forgo seeing a clinician entirely.

Then there’s the scenario in which patients learn after the fact that their telehealth visit wasn’t fully covered: In some circumstances patients could get hit with a surprise bill, although many medical practices strive to ensure that doesn’t happen.

The shifting coverage for telemedicine visits is throwing a wrench into the decision-making equation for patients. Several physicians interviewed for this story said that even the prospect of expanded coverage expiring is sowing confusion about what kinds of visits will remain covered, whether they’ll be fully or partially paid for, which insurers will cover them, and for how long.

“What’s been on my radar has been generally the uncertainty and constantly changing dates that the insurers have on their websites, which has just created a sense of uncertainty about where we’re headed,” said Ateev Mehrotra, a hospitalist whose research as an assistant professor at Harvard Medical School focuses on telemedicine.

Licurse worries in particular about the effect that uncertainty could have on small medical practices with tight margins and little room for error, which might not be able to afford to help patients shoulder cost sharing or to lose on an expected stream of telehealth revenue. “To have a provider feel financial pressure to offer less telehealth and bring more patients into the office — because they have to pay the bills and keep the lights on and keep their practice running — is a pressure providers shouldn’t have to face,” he said.

The pandemic-era surge in interest in telemedicine has sparked calls to make expanded coverage of virtual care benefits permanent — especially since the pandemic and its effects are slated to linger in some form for at least another year. But some insurers — and even providers who like the technology — are balking at the idea because of concerns about overuse of health care resources.

“The very advantage of telehealth — the fact that it makes care more convenient — is also its Achilles’ heel, in the sense that it can make care too convenient,” Mehrotra said. The ease of conducting a visit via smartphone from home may lead patients to see their doctor in instances in which such a visit wasn’t necessary — a concern for health insurers worried about their bottom line, and for the system as a whole as health care spending soars.

Compared to private insurers, government payers may be more amenable to making pandemic-era telehealth changes into permanent policy. The Centers for Medicare and Medicaid Services’ waivers are in effect until Covid-19 is no longer considered a public health emergency. In August, the agency proposed codifying some of them and, as a stopgap measure, extending the expiration dates through the end of the year.

Meanwhile, commercial health insurance trade group America’s Health Insurance Plans, or AHIP, which is tracking the extensions among commercial insurers, said it was “still awaiting information on what changes will remain in place beyond the public health emergency.”

AHIP did not respond to STAT’s request for comment about why the changes were not made permanent among private health plans, but instead pointed to an infographic on its website that read in part: “Many changes have been made during the Covid-19 crisis to significantly expand the use of virtual care. If these changes go away, telehealth may be rolled back rather than becoming a sustained and transformational approach to patient care.”

Todd Ray, a senior vice president at BCBS Tennessee, said in a statement that the plan’s decision to extend expanded telehealth coverage beyond Oct. 1 will remove a potential barrier to care for enrollees.

“We’re supporting our members who want to get their routine and preventive health services knocked off the ‘to-do’ list. This is especially important as the Covid-19 pandemic continues and flu season approaches,” said Todd Ray, a senior vice president at BCBS Tennessee, in a statement. BCBS Tennessee’s policies only apply to seniors who are part of private Medicare Advantage plans.

Neither company responded to STAT’s request for the amount that patients would be expected to pay without the waivers, saying the cost varied by individual plan.

Mehrotra said he wants to see all private insurers pledge to pay for telemedicine visits — either via phone or video — at the same rate as in-person visits for the duration of the Covid-19 public health emergency, as defined by the federal government. At that point, “each insurer can choose whatever decision they want about telemedicine policy — we can have that debate now or later — but for now I think we need that certainty,” Mehrotra said.

Pelosi, Seeking to Insulate House Majority, Presses Plan to Lower Health Costs

Image result for Pelosi, Seeking to Insulate House Majority, Presses Plan to Lower Health Costs images

Source: The New York Times, by Sheryl Gay Stolberg

Speaker Nancy Pelosi is preparing to unveil a sweeping plan to lower the cost of health care, moving to address the top concern of voters while giving moderate Democrats who face tough re-election races a way to distance themselves from the Medicare for All plan embraced by the progressive left and derided by Republicans as socialism.

The legislation, timed to coincide with the 10th anniversary of the Affordable Care Act, is part of a major push by Democrats to position themselves as the party of health care before the 2020 elections. Former President Barack Obama will support the effort, appearing with Ms. Pelosi at American University in Washington on March 23, 10 years to the day he signed the Affordable Care Act into law.

While the measure has little chance of survival in the Republican-controlled Senate, it is the latest evidence that Democratic leaders, determined to protect their House majority and the moderate lawmakers who helped them to power, are looking for ways to distinguish their rank and file from the party’s presidential nominees.

The plan bears no resemblance to Medicare for All, the national health insurance system championed by Senator Bernie Sanders of Vermont, the self-described democratic socialist. And it omits a “public option” to create a government-run health insurer, an idea embraced by former Vice President Joseph R. Biden Jr., the Democratic front-runner.

In steering clear of the ideas promoted by both leading presidential candidates, Ms. Pelosi is hoping to protect the so-called front-liners who flipped Republican seats in 2018 and delivered Democrats the majority.

The speaker’s new proposal is aimed at reducing costs under the current health bill, according to people familiar with it, who insisted on anonymity to describe a plan that was not yet public. Details are still being finalized, and Ms. Pelosi — who was to meet Monday evening with Democratic committee chairs to discuss a response to the coronavirus epidemic — has not yet shared them with her rank and file. The speaker’s office declined to comment.

The plan could be unveiled as early as this week, though coronavirus could upend that timeline. In eschewing Medicare for All, Ms. Pelosi is turning away from a proposal that does not have the votes to pass the House and has divided Democrats on Capitol Hill.

Instead, the speaker is expected to propose a series of steps to make health care more cost-effective under the Affordable Care Act, including expanding tax credits and subsidies to help people buy insurance and creating a national program to help cover expenses for those with medical conditions. The plan is expected to spotlight ideas put forth by vulnerable freshmen like Representatives Lauren Underwood of Illinois and Angie Craig of Minnesota.

But Ms. Pelosi’s reluctance to embrace Mr. Sanders’s bold vision may draw the ire of her caucus’ left wing, which is pushing for a vote on Medicare for All. Her decision to shy away from the public option is especially notable, given that the House included such a system when it passed its version of the Affordable Care Act in 2009. The provision was later stripped out by the Senate.

“I think it’s way too cautious an approach,” said Representative Ro Khanna, Democrat of California and a national co-chairman of Mr. Sanders’s campaign, though he added that Democrats would most likely embrace any plan that lowered costs, even incrementally.

“No one is opposed to a pragmatic step that’s feasible,” he said. “What we’re opposed to is a lack of imagination and boldness in not giving a vote on policies that economics and health experts are saying is what the country needs.”

But Leslie Dach, a Democratic strategist and the chairman of Protect Our Care, an advocacy group, said it was important for Democrats to spotlight what they could agree on, especially after a string of presidential primary debates where Democrats beat up one another over their health care plans instead of going after President Trump.

“If you do the polling, 80 percent of the people want to lower costs, and they want to protect critical things like pre-existing conditions. That unifies the country and unifies the party,” Mr. Dach said. “What we have had is a debate with tremendous missed opportunities. Democrats should have been up there reminding people what Donald Trump has been doing to their health care, not arguing as much about where they want to go.”

Polls show the public is deeply concerned about the high cost of health care but divided over what to do about it. A recent poll by the Kaiser Family Foundation found that a slight majority of respondents — 53 percent — favored a Medicare for All approach that would cover everyone on a single government plan. A much larger majority, 65 percent, favored a public option.

Republicans have latched onto Mr. Sanders and Medicare for All as a way to paint Democrats as socialists, a strategy that is unlikely to change no matter what proposal Ms. Pelosi puts forth or who becomes the Democratic nominee.

“Voters have watched as the Democratic Party has moved further and further left, to the point where now a majority of their members support canceling private health care entirely for BernieCare,” said Dan Conston, the president of the Congressional Leadership Fund, a political action committee affiliated with House Republicans. Such positions, he said, “make the argument that Democrats have become socialists a particularly effective one, no matter how much they now try to run away from it.”

The Affordable Care Act anniversary comes as the law itself is in fresh peril. It has survived numerous Republican attempts and a vow by Mr. Trump to repeal it, as well as a string of court challenges.

But the Supreme Court, which has twice ruled to leave most of the provisions intact, recently agreed to hear a third case, which could wipe out the Affordable Care Act entirely. When Democrats took over the House in January 2019, they voted to intervene in the case, Texas v. U.S., which was brought by conservative state attorneys general seeking to overturn the law.

Democrats campaigned aggressively in 2018 on lowering costs and protecting health coverage, and they have already taken some steps to make good on those promises.

In May, they passed legislation to reverse Trump administration rules that allowed the expansion of health care plans that did not have to comply with the Affordable Care Act’s mandated coverage of pre-existing medical conditions. And in December, the House voted to lower the rising cost of prescription drugs by empowering the federal government to negotiate prices with pharmaceutical manufacturers.

But like most legislation passed by House Democrats, the two health bills are languishing in the Senate, where Senator Mitch McConnell, Republican of Kentucky and the majority leader, refuses to take them up.

The legislation Ms. Pelosi is drafting is based in part on the Protecting Pre-Existing Conditions & Making Health Care More Affordable Act, a measure introduced about a year ago by the three chairmen whose committees have jurisdiction over health care: Representative Frank Pallone Jr. of New Jersey, the Energy and Commerce chairman; Representative Richard E. Neal of Massachusetts, the Ways and Means chairman; and Representative Robert C. Scott of Virginia, the Education and Labor chairman.

That bill aims to lower health insurance premiums by expanding eligibility for premium tax credits beyond 400 percent of the federal poverty line. It also increases the size of tax credits for people in all income brackets. It would create a so-called reinsurance program, which would provide government funds to help insurers offset the cost of patients with expensive medical conditions. And it would make subsidies more generous for people with incomes below 250 percent of the federal poverty line.

Other Democrats, including Ms. Underwood and Ms. Craig, have put forth similar ideas. Ms. Underwood is the chief sponsor of a stand-alone plan to expand tax credits. Ms. Craig is promoting federal funding for states to run their own programs to reduce insurance premiums.

It is measures like Ms. Pelosi’s — not the kind of systemwide overhaul advocated by Mr. Sanders — that House Democrats want to focus on as they seek to maintain their majority.

“Our front-liners have been very focused on their message, which has been strengthening the A.C.A., making sure we’re continuing to cover pre-existing conditions, and making sure that we resist the constant cuts to Medicaid and Medicare and even Social Security that have been proposed,” said Representative Katherine M. Clark, Democrat of Massachusetts and a member of the leadership. “Whatever’s happening on the national level, I don’t think their strategy is going to change.”

Survey: 20 Million Americans Have Crowdfunded to Help Pay Medical Bills

Image result for Survey: 20 Million Americans Have Crowdfunded to Help Pay Medical Bills images

Source: The Hill, by Jessie Hellmann

An estimated 8 million Americans have started crowdfunding campaigns through websites like GoFundMe to pay for medical expenses for themselves or someone in their households, according to a survey released Wednesday,

Another 12 million Americans said they have started a campaign for someone else, according to the NORC at the University of Chicago survey.

Twenty percent of Americans said they donated to such campaigns.

The proliferation of these online fundraisers to pay for medical bills is a symptom of the increasing costs of health care, even for those who have insurance.

“As annual out-of-pocket costs continue to rise, more Americans are struggling to pay their medical bills, and millions are turning to their social networks and crowdfunding sites to fund medical treatments and pay medical bills,” said Mollie Hertel, a senior research scientist at NORC, in a press release.

“Although about a quarter of Americans report having sponsored or donated to a campaign, this share is likely to increase in the face of rising premiums and out-of-pocket costs,” Hertel added.

GoFundMe casts itself as the “leader in online medical fundraising,” with 250,000 medical campaigns launched on its website each year.

“I would love nothing more than for ‘medical’ to not be a category on GoFundMe,” the website’s CEO, Rob Solomon, told Kaiser Health News last year.

“The reality is, though, that access to health care is connected to the ability to pay for it. If you can’t do that, people die. People suffer. We feel good that our platform is there when people need it,” he added.

The NORC survey found 85 percent of respondents thought the government should be responsible for providing help when medical care is unaffordable.

Eighty-three percent said the same of hospitals or clinics.

The poll was conducted between Nov. 8 and Nov. 16, 2019, and included 1,020 interviews with a nationally representative sample. It has a margin of error of 4 percent.

Trump’s State of the Union Address: 3 Healthcare Takeaways

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Source: Becker’s Hospital Review, by Ayla Ellison

In his State of the Union address Feb. 5, President Donald Trump touched on several health policy issues and reiterated his desire to lower healthcare costs.

Three takeaways:

1. Price transparency. During the State of the Union address, President Trump said more transparency in the healthcare industry would increase competition and bring costs down. He called on hospitals, drug companies and insurers to “disclose real prices.”

“I am asking the Congress to pass legislation that finally takes on the problem of global freeloading and delivers fairness and price transparency for American patients,” he said. “We should also require drug companies, insurance companies and hospitals to disclose real prices to foster competition and bring costs down.”

2. Drug costs. President Trump said he wanted Congress to take action to lower drug costs.

“It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place,” he said. “This is wrong, unfair, and together we will stop it. We will stop it fast.”

President Trump didn’t say how he wanted to achieve this goal, but his administration recently released a proposal to lower drug prices for Medicare beneficiaries. Under the proposed rule, drug manufacturers would no longer be able to give rebates to pharmacy benefit managers, but they would be allowed to offer discounted prices directly to consumers.

3. Plan to curb HIVDuring the State of the Union, President Trump pledged to end the HIV epidemic in the U.S.

“In recent years we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach,” he said. “My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”

HHS Secretary Alex Azar provided more details on the plan, saying the goal is to reduce new infections by 75 percent over a five-year period and to “end the HIV epidemic in America” by 2030, according to The New York Times.

Mr. Azar said the funds requested by top health officials to achieve this goal will be in President Trump’s budget next month, according to The Washington Post.

Insurers: Price Transparency Rule Puts ‘Staggering,’ Expensive Burden On Us

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Source: FierceHealthcare, by Robert King

Insurers charge that the Trump administration’s price transparency rule will cost 26 times more than estimated, and the amount of data they must disclose is “staggering.”

Insurer groups blasted the proposed rule released by the Treasury, Labor and Health and Human Services departments late last year that would force insurers to disclose negotiated rates for in-network providers and allowed amounts for out-of-network care. The crux of comments from insurers on the rule focused on the massive burden and cost for implementation and that the data would confuse consumers.

The Blue Cross Blue Shield Association (BCBSA), which represents 36 Blues plans, said that an economic analysis from the firm Bates White found that the total setup and maintenance cost for an insurer to comply with the rule was $13.63 million. That is 26 times higher than the administration’s estimate of $510,000.

“Some plans have indicated they would be forced to run two sets of tools—one designed to meet member shopping needs and another implemented only to meet the requirements of the proposed rule,” BCBSA said in submitted comments.

The rule would require plans to publish machine-readable files with their payment amounts for all health services and items. Insurers would also be required to post a tool that can help consumers get an estimate on out-of-pocket costs for any item or service before they get care.

“The sheer volume of data health plans would be obligated to disclose is staggering,” BCBSA said. “There are more than 94,000 codes that exist currently … covering institutional inpatient, outpatient and professional claims.”

America’s Health Insurance Plans (AHIP) said in comments that the proposal appears to be more targeted at providing data for third-party app developers than “ensuring consumers have access to meaningful, personalized data.”

The Trump administration is essentially asking insurers to share “both their trade secrets and their enrollees’ sensitive personally-identifiable information with app developers that are not bound by the same heightened level or privacy and security rules that apply to health insurance providers,” AHIP said.

Posting just the data also could be confusing for consumers that don’t have the necessary context, argued the Association for Community Affiliated Plans, which represents 67 nonprofit and community-based safety net plans.

“In the absence of quality data, consumers may determine that higher cost equates to higher value, select the higher-cost providers, and ultimately drive up medical expenses,” the group said in comments.

The reaction from provider groups was more mixed. Golden Valley Memorial Healthcare, a rural hospital in Missouri, wants the rule to provide the cost-sharing information to providers as well as patients.

“Patients reasonably turn to providers for this information when contemplating or scheduling health care services, but providers often face barriers in accessing the necessary details from insurers to provide a timely, accurate estimate,” the hospital said in comments.

The American Hospital Association (AHA) said it agrees with the proposal to improve patient access to cost-sharing information. But AHA vehemently disagreed with the proposal for insurers to release all negotiated rates.

AHA argued that the First Amendment of the Constitution doesn’t “permit compelled public disclosure of such confidential and trade secret pricing information.”

The Trump administration also doesn’t have the legal authority to force payers to disclose negotiated rates, AHA said. The Affordable Care Act (ACA) gives the federal government authority to compel certain information regarding coverage, including how a health plan must be certified to be on the ACA’s exchanges.

But AHA contends that the administration can’t require disclosure of negotiated rates, because they refer to price and not coverage.

The AHA is used to making these types of arguments because it is among several hospital groups suing the Trump administration over a final rule that requires hospitals to post payer-negotiated rates. While insurers have also opposed that rule, none have joined the lawsuit.

Last Updated 05/05/2021

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