Health Care Groups Dive Into Property Tax Ballot Fight, Eyeing Public Health Money

Healthcare groups dive into property tax ballot fight, eyeing public health  money

Source: Kaiser Health News, by Angela Hart

A November ballot initiative to raise property taxes on big-business owners in California is drawing unconventional political support from health care power players and public health leaders.

They see Proposition 15 as a potential savior for chronically underfunded local health departments struggling to respond to the worst public health crisis in more than a century. The initiative would change California’s property tax system to tax some commercial properties higher than residential properties, which backers say could generate billions to help local governments pay for critical public health infrastructure and staffing.

Without such additional state or federal funding, local governments could be forced to make deeper budget cuts in health and other departments next year as the COVID-19 pandemic continues to strain city and county finances.

“When you’re talking about health care, you’re talking about money,” said Anthony Wright, executive director of Health Access California, a Sacramento-based consumer advocacy group. “This is the major revenue measure on the ballot this year, and it’s an opportunity to fund public health at the place where the main responsibility for public health lies — at the county level.”

At least that’s how health care advocates are casting the tax hike. But there’s no guarantee that if the measure passes counties would use new revenue to address COVID-19 or other health care needs. And some rural counties fear they would lose money if the ballot measure passes, which could undercut public health efforts.

Support within the health care and local government worlds is not unanimous. The powerful California Hospital Association opposes the measure because it would result in higher taxes on private and investor-owned hospitals, said spokesperson Jan Emerson-Shea. Nonprofit hospitals, including those run by Sutter Health, Kaiser Permanente and Dignity Health, are exempt from paying property taxes despite their regular high revenue. They would remain exempt under the initiative. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)

“This new tax will mean millions of dollars will be taken away from patient care, in perpetuity,” Emerson-Shea said.

Proposition 15 would amend California’s landmark 1978 property tax initiative, Proposition 13, which capped commercial and residential property tax rates at 1% of assessed value at the time of purchase, and limited annual increases thereafter to 2%. The drop in property taxes as a result of the initiative decimated a major revenue source for public schools and social welfare programs, leaving many underfunded.

Voters are now being asked to allow higher taxes for business owners with commercial holdings valued at more than $3 million. If passed, the measure could generate up to $11.5 billion a year, according to the nonpartisan state Legislative Analyst’s Office. It would not apply to residential properties.

Forty percent of annual revenue would be distributed to K-12 schools and community colleges, with 60% sent to cities and counties. Nothing in the measure would require new local revenue to be spent on health care, but supporters say it’s their best hope after losing $134 million in state public health money this year as one-time funding for specific programs expired. At the same time, slammed by a projected $54 billion deficit, Gov. Gavin Newsom and state lawmakers declined this year to increase funding for local health departments to combat COVID-19 and rebuild public health infrastructure.

Sponsors of Proposition 15, including the California Teachers Association and the Service Employees International Union California, argue it’s an overdue change that would tax wealthier enterprises in exchange for funding vital school and health care programs. They point out that the initiative, supported by Newsom and Democratic presidential nominee Joe Biden, would require schools and local governments to disclose all new revenue they receive and how money is spent.

If passed, money from the measure would begin flowing to schools and counties in 2022 at the earliest.

Opponents of the measure, including the California Chamber of Commerce, the California Republican Party and the Howard Jarvis Taxpayers Association, say hiking taxes on commercial property owners would harm struggling businesses hit hard by COVID-related closures.

“This is being pushed as a panacea cure-all, but at the end of the day, there is no accountability for where these funds go,” said Michael Bustamante, a spokesperson for the “No on Prop 15” campaign. “There are, without question, an infinite number of needs, but there is no specificity with what it can or can’t be spent on.”

Kat DeBurgh, executive director of the Health Officers Association of California, which represents the state’s 61 local health officers and has not taken a position on the initiative, said ongoing, unrestricted revenue could actually benefit counties by allowing them to spearhead public health programs that address local needs.

At present, counties are limited in what they can do with their public health dollars, she said. Most additional funding in recent years has largely been earmarked for specific programs or diseases, such as hepatitis C and HIV, and counties are not allowed to spend it on their COVID-19 response or other public health activities.

“Maybe your community’s highest priority is not something easily funded by one of these grants. Many rural areas in our state don’t have access to clean drinking water, for example,” DeBurgh said. “And our greatest demand — more public health workers — can’t be funded with grants or one-time money.”

Health care leaders also argue the initiative could help support community clinics and public hospitals that provide care for uninsured people, who have also suffered financially during the pandemic.

“What we’re really trying to avoid is having to balance the budget on the backs of people who need services,” said Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California. “Our public health system has clear inequities that we need to address, and additional funding can help fill in the gaps at the county level.”

Hicks said Planned Parenthood, which provides sex education in California public schools, is supporting the initiative not only to improve public health, but also because she worries programs like sex education will be on the chopping block as the state experiences unprecedented job and economic losses.

“Those types of programs are the first to get cut when there’s not enough funding,” she said.

Small, rural counties could also lose funding, county assessors said.

While the initiative would likely raise taxes on large commercial property owners who have seen their land and property appreciate in value over the years, it would eliminate property taxes for other business assets, such as machinery and equipment, for the first $500,000 in value.

Counties that haven’t seen land values climb as high as those in coastal regions like the Bay Area may not collect more property taxes while also losing revenue from the tax cut on other business assets.

Chuck Leonhardt, the elected assessor for rural Plumas County, projects that his county could be one of the losers.

“This would take $90 million in assessed value from our tax roll at the beginning, and then I’d have to reassess 2,000 commercial properties,” he said. “Many of us rural counties don’t feel we’ll benefit from doing these reappraisals and my expectation is we could lose some money.”

Even among supporters in public health, some fear that any potential windfall for counties would be allocated based on the whims of local politics.

“Even though I support it, I am skeptical that this money will go to the public health programs and basic infrastructure we so desperately need because public health has no constituency,” said Bruce Pomer, a public health expert and chief lobbyist for the California Association of Public Health Laboratory Directors.

He pointed to Sacramento County, where the sheriff’s department received a larger share of the $181 million in federal COVID-19 relief money than the county public health department.

“I’m worried we’ll see the same thing we saw with Sacramento County,” Pomer said.

Pfizer Suit Could Be an ‘Earthquake’ for Drug Pricing

Pfizer Suit Could Be an 'Earthquake' for Drug Pricing | Barron's

Source: Barron’s, by Eleanor Laise

Last year, Pfizer posted a billboard outside its midtown Manhattan headquarters showing a larger-than-life patient smiling at his partner. “Dedicated to the brave of heart,” it read.

The patient, Walter Feigenson, 72, of Portland, Ore., says he was paid roughly $1,000 for taking part in the launch of tafamidis—sold by Pfizer (ticker: PFE) under the names Vyndaqel and Vyndamax—a $225,000-a-year treatment for a potentially fatal heart condition. The price, which makes tafamidis the most expensive cardiovascular drug ever launched in the U.S., is “unconscionable” and “completely unjustified,” Feigenson said in an interview with Barron’s.

As a retired entrepreneur living on Social Security income of about $26,000 a year, Feigenson has his prescription covered through Medicare and funding from independent charities, filling in the gaps with free drugs he gets through a Pfizer program for lower-income patients. “I’m in a race to see if I can bankrupt Medicare faster than anybody else,” he says. “I’m not cheap.”

If Pfizer has its way, taxpayers could soon be on the hook for many more doses of tafamidis. In June, the pharmaceutical giant filed a lawsuit against the federal government in U.S. District Court for the Southern District of New York, seeking a judgment in favor of proposed patient-assistance programs that would allow the company to help cover tafamidis copays for many Medicare beneficiaries.

Such programs, which can be sponsored directly by drug companies or independent charities funded largely by the pharmaceutical industry, often cover much or all of patients’ out-of-pocket drug costs, leaving third-party payers such as insurers and Medicare to pick up most of the tab.

The case could reverberate far beyond Pfizer and patients prescribed tafamidis. Patient-assistance programs covering out-of-pocket costs remove a powerful market force—patients’ price sensitivity—that would otherwise push down drug prices, and drugmakers can use them to boost sales of pricey medications, researchers say. A ruling for Pfizer “would be a major earthquake” that could send drug prices soaring, with taxpayers footing much of the bill, says Ge Bai, an associate professor at Johns Hopkins Carey Business School and the Bloomberg School of Public Health, who has studied patient-assistance programs.

Pfizer’s lawsuit takes aim at federal policies that prohibit drugmakers from providing direct copay assistance to Medicare beneficiaries and restrict their funding of and communications with independent patient-assistance charities. Companies straying outside those policies risk violating federal anti-kickback laws, which prohibit them from offering anything of value to induce Medicare patients to purchase the company’s drugs.

Over the past few years, the Department of Justice has collected more than $1 billion in settlements from pharmaceutical companies, including Pfizer itself, that allegedly violated these prohibitions. A Pfizer victory in the tafamidis case could stymie such enforcement efforts, says Max Voldman, an attorney at Constantine Cannon who specializes in health-care industry fraud. A decision in the case could come early next year.

Pfizer and several other drugmakers involved in the settlements have said that their charitable giving helps people lead healthier lives and that all patients deserve access to their prescriptions.

The fact that Pfizer can’t offer the same type of support to Medicare patients that it provides to the commercially insured is a “fundamental inequity,” says Suneet Varma, global president of Pfizer’s rare-disease unit. “That’s what brought us to this point.” As for tafamidis’ price, he says it’s “responsible, because of the transformational value this delivers for patients and the size of the rare-disease population it treats.”

The legal battle is playing out as President Donald Trump and lawmakers of both parties look for ways to rein in Medicare Part D drug spending, which grew nearly 10% annually from 2009 to 2018, reaching $168 billion, according to the Medicare Payment Advisory Commission.

“Tafamidis is a canary in the coal mine” that will help determine the future pricing of similar drugs, says Dr. Dhruv Kazi, a cardiologist and health economist at Beth Israel Deaconess Medical Center in Boston. His research has found that treating all patients eligible for tafamidis—estimated at 120,000 people—would boost total annual U.S. prescription-drug spending by 9%, or $32 billion. If there’s one thing we’ve learned from the pandemic, he says, it’s that “even in wealthy countries like the U.S., ultimately health-care resources are limited, and we have to decide what to opt into and what to forgo.”

Many Medicare patients prescribed high-cost drugs know all about those unpleasant trade-offs, because Part D places no cap on their out-of-pocket spending. Even when they reach catastrophic coverage, they’re responsible for 5% of the drug costs, which is often unaffordable.

Independent patient-assistance charities have stepped into the breach, growing rapidly in the years after Part D took effect in 2006. These nonprofit organizations can take cash donations from drugmakers and use them to help cover Medicare patients’ copays and other out-of-pocket costs, so long as they’re following guidelines issued by the Department of Health and Human Services’ Office of Inspector General that are meant to ensure their independence. Drugmakers aren’t supposed to exert any control over the charities, for example, or receive data that can correlate their donations with sales of their own drugs.

From 2006 to 2015, total giving by major independent charities such as the Patient Access Network Foundation and HealthWell Foundation climbed more than 750%, to $1.4 billion, according to research by the U.S. Treasury’s Office of Tax Analysis. Since then, several charities settled Department of Justice allegations that they helped drug companies steer donations to patients taking their own drugs. Even so, five major patient-assistance charities gave a total of more than $1.1 billion to assist patients in 2018, according to Internal Revenue Service filings.

The programs help drive up drug prices and boost drugmakers’ profits, critics say. The median annual cost of drugs covered by the programs is $1,157, compared with $367 for drugs not covered, and off-patent brand-name drugs are more likely to be covered than their generic equivalents, according to a 2019 study by Bai and others that examined 274 disease-specific programs offered by the major independent charities.

A drugmaker’s $1 million donation to a charity that helps Medicare patients access high-price drugs “has the potential to generate up to $21 million for the sponsor company, funded by the U.S. government,” according to a 2017 Citigroup report. Drugmakers also get tax deductions for their contributions to the charities.

The charities tend to ignore patients who may most need their help, researchers say. Ninety-seven percent of the programs exclude the uninsured from eligibility, Bai’s study found, ensuring that their biggest donors, the drugmakers, get paid for each prescription the charities help cover. Uninsured patients may be eligible to receive free drugs directly from drugmakers, says Krista Zodet, president of the HealthWell Foundation. “One of the main reasons foundations like us are in place is that we can help Medicare patients” in ways that drug companies can’t, she says.

Tafamidis is the only Food & Drug Administration–approved treatment for transthyretin amyloid cardiomyopathy, or ATTR-CM, which causes the heart to stiffen and limits its ability to pump blood. Even before Pfizer filed its lawsuit, some doctors involved in tafamidis clinical trials took the unusual step of publicly criticizing its $225,000 price tag. Early this year, a JAMA Cardiology article co-written by a principal investigator in a tafamidis clinical trial called the drug a “particularly egregious example of price gouging.”

To determine tafamidis’ price, says Pfizer’s Varma, the company first considered the drug’s clinical value, which includes prolonging life and reducing hospitalizations.

CMS Expands List Of Telehealth Services That Can Get Medicare Reimbursement

CMS expands Medicare coverage for telemedicine due to COVID-19

Source: Fierce Healthcare, by Robert King

The Centers for Medicare & Medicaid Services (CMS) has added 11 new telehealth services that Medicare will reimburse, including cardiac rehabilitation services.

The additions, announced Wednesday, are part of the latest push by the agency to accelerate use of telehealth by removing reimbursement barriers. The agency is also giving support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies to expand access to telehealth.

“Medicaid patients should not be forgotten, and today’s announcement promotes telehealth for them as well,” said CMS Administrator Seema Verma in a statement.

The expansion means that the 11 telehealth services will be reimbursed for the duration of the public health emergency amid the COVID-19 pandemic. The emergency declaration was renewed for another 90 days earlier this month.

Verma has hinted that some of the flexibilities to get Medicare telehealth reimbursement could remain after the pandemic.

The newly added services include certain neurostimulator analysis and programming services and cardiac and pulmonary rehab services. The additions mean Medicare will pay for a total of 144 telehealth services.

“Between mid-March and mid-August 2020 over 12.1 million Medicare beneficiaries—over 36%—of people with Medicare Fee-For-Service have received a telemedicine service,” CMS said in a release.

CMS also released a new toolkit (PDF) to give states more guidance on how to expand use of telehealth in Medicaid and CHIP. The toolkit gives examples to help states identify services that could be accessed via telehealth and how telehealth can be reimbursed after the public health emergency expires.

Attorney General Becerra Takes Action to Ensure Californians Have Access to Mental Health Care

California joins legal challenge over USPS reductions - Los Angeles Times

Source: EIN Presswire

California Attorney General Xavier Becerra today urged California’s four largest health insurance providers: Anthem Blue Cross, Blue Shield of California, Health Net of California, and Kaiser Permanente, to demonstrate their compliance with state and federal mental health parity laws. In letters addressed to each of the managed care insurance companies, the Attorney General requested information that would help determine if they are providing coverage for mental health benefits and services without putting limitations or conditions on the coverage that are more restrictive than permitted by the law. Equal treatment for mental health conditions in insurance plans is mandated by state and federal laws, including the California Mental Health Parity Act, the federal Mental Health Parity and Addiction Equity Act of 2008, and the Affordable Care Act (ACA). The plans have until November 16, 2020, to voluntarily comply with the information request.

“One out of every six Californians experiences some type of mental illness, which is why it is important to ensure our mental health laws are being followed,” said Attorney General Becerra. “It is the job, mandated by the law, of health insurance providers to make access to care for mental health conditions as accessible as care for a medical illness. Now, when people are seeing their mental health worsen as they navigate the COVID-19 pandemic, is a critical time to ensure those who need it have access to care.”

Despite multiple laws, including the California Mental Health Parity Act and the ACA, which expanded access to mental health treatment across the country, many Californians still struggle to find appropriate mental health treatment. Many Californians with insurance are also exponentially more likely to go out of network for mental health treatment than for medical services. According to a survey by the Kaiser Family Foundation/California Health Care Foundation, two-thirds of the individuals surveyed reported that they or one of their family members sought but were unable to locate mental health services.

In order to investigate mental healthcare coverage, the Attorney General requested documents and information that would ensure Anthem Blue Cross, Blue Shield of California, Health Net of California, and Kaiser Permanente are following mental health parity laws.

A copy of the letter to Anthem Blue Cross is available here. A copy of the letter to Blue Shield of California is available here. A copy of the letter to Health Net of California is available here. A copy of the letter to Kaiser Permanente is available here.

Majority Of Americans Don’t Want Preexisting Condition Protections Eliminated

Majority of Americans don't want preexisting condition protections eliminated: poll

Source: The Hill, by Nathaniel Weixel

A majority of Americans polled do not want the Supreme Court to overturn ObamaCare’s protections for people with preexisting conditions, according to a new survey from the Kaiser Family Foundation.

Even among Republicans, 66 percent of respondents said they did not want to see the preexisting condition protections overturned.

Overall, the poll showed 79 percent of respondents do not want the court to cancel coverage protections for Americans with preexisting conditions.

But only 58 percent of respondents said they want the court to keep the health law in its entirety, with a large partisan gap between Democrats and Republicans. According to the poll, 89 percent of Democrats want to keep the entire law, but only 16 percent of Republicans do.

The Supreme Court is set to hear arguments in a Republican-backed lawsuit that seeks to strike down the entire law next month.

Despite attempts by congressional Republicans to downplay the likelihood of the law being overturned, the Trump administration supports the challenge.

President Trump does not have a plan in place if the lawsuit is successful, and other plans by GOP lawmakers would not offer the same level of protections. Yet 85 percent of Republicans who were polled said Trump “has a plan” to maintain the protections if the law is overturned.

Eliminating ObamaCare would leave roughly 21 million Americans without health insurance, and would allow insurance companies to once again charge more or deny coverage to people with preexisting conditions.

Democrats have been drilling on the lawsuit this week during the confirmation hearings of Supreme Court nominee Judge Amy Coney Barrett, whom they argue will be the deciding vote against the law.

The Kaiser poll also showed that the public trusts Democratic presidential candidate Joe Biden on health care far more than Trump.

According to the poll, Biden has the edge over Trump on all health care issues, including among voters age 65 and older.

The poll found Biden had at least a 20-percentage point advantage among voters on who they think has the better approach to making decisions about women’s reproductive health choices and services, determining the future of ObamaCare and maintaining protections for people with preexisting conditions.

On COVID-19, 54 percent of respondents said they prefer Biden’s plan for dealing with the pandemic, and 50 percent said they prefer his plan for developing and distributing a vaccine.

The survey was conducted Oct. 7-12, after the first presidential debate and Trump’s announcement that he had tested positive for COVID-19.

The margin of error is plus or minus 3 percentage points for the full sample of 1,207 respondents.

Hospitals Could See 10% Drop In Admissions In 2020: KFF

Hospital bed

Source: Fierce Healthcare, by Tina Reed

While the overall number of admissions in U.S. hospitals has rebounded since historic lows experienced early on in the COVID-19 pandemic, it hasn’t been enough to make up for the overall loss in business, according to a new Kaiser Family Foundation analysis.

Overall, total hospital admissions dropped as low as 69% of predicted levels during the second week of April as stay-at-home orders required elective surgeries to be canceled, according to electronic medical record data from the Epic Health Research Network.

The analysis looked at inpatient hospital admission volume from 27 healthcare organizations in the U.S. from the beginning of 2018 through Aug. 8, 2020. The data, which involved 22 million patients who were either discharged or died as of Sept. 13, represented 162 hospitals across 21 states.

As restrictions eased, admissions rebounded to a high of more than 94% in early July but dipped slightly by August to admissions of about 91% of predicted levels.

If admissions remain at about 90% of projected levels for the rest of the year, total admissions will be about 10.5% below the predicted volume for 2020, the analysis found. If restrictions are put on elective procedures again in the latter part of the year, the share of “lost” admissions will be higher, the analysis said.

“It could have serious consequences both for hospitals’ financial stability and the health of patients,” authors of the report wrote.

The report also found:

  • * Hospitals were impacted in particular when it came to non-COVID-19 admissions among patients 65 and older and had about half as many admissions in late March and April compared to projections. Their admissions have stabilized closer to normal levels at about 80% to 85% of their predicted volumes.

Admissions for patients younger than 65 were about 90% of predicted levels during the same period. That could actually provide a positive change in payer mix for some hospitals as the majority of younger patients have private insurance, which reimburses at a higher rate than Medicare and could help mitigate some revenue decline from admissions, the authors wrote.

  • *Non-COVID-19 admissions for both men and women dropped to about 60% of predicted admissions in April before rebounding. But admissions for female patients remained about 20% higher than for male patients, largely due to women’s admissions for childbirth, the analysis said.
  • * Hospitals in the Northeast experienced the biggest drop in non-COVID-19 admissions, with admissions falling to a low of roughly 50% of predicted admissions in April. But they have since increased to nearly 90% of predicted levels in August. In the West, hospitals did not see as big of a drop in admissions but also did not see as much of a rebound. In August, admissions were at 83% of predicted levels.

Newsom Tells Calif. To Not Expect ‘Mass Availability’ Of Vaccine Until 2021

Gavin Newsom wearing a suit and tie: FILE - In this June 26, 2020 file photo, Gov. Gavin Newsom holds a face mask as he urges people to wear them to fight the spread of the coronavirus during a news conference in Rancho Cordova, Calif.

Source: SF Gate, by Amy Graff

California Gov. Gavin Newsom said Monday under the best-case scenario, an extremely limited supply of a COVID-19 vaccine approved by the Food and Drug Administration will be available by November or December, countering President Donald Trump’s repeated assurance to the American people that a vaccine could be widely available before the year’s end.

Newsom expects California to receive 1 to 2 million doses in the first vaccine delivery, and this would be the amount needed to inoculate people working in the health care system.

A major inoculation effort — where anyone could go to their local pharmacy for a vaccine — is highly unlikely until next year, he said.

“It is simply unrealistic,” said Newsom. “We don’t anticipate mass availability until 2021.”

The governor said the big question now is whether vaccines will be widely available in the first, second or third quarter of 2021.

Newsom also announced at his regular Monday press briefing the state has created a task force made up of 11 scientists to conduct an independent medical review of the safety of any FDA-approved vaccine before administering it to Californians.

“We don’t take anyone’s word for it,” said Newsom, noting that experts on the review committee hail from top universities such as UC Berkeley and Stanford.

The state is 1 of 5 jurisdictions to submit an advance plan for vaccine distribution and as a result received $29 million from the federal government, the governor said. Under the state plan, the first phase of vaccine distribution would prioritize high-risk individuals including health care workers, seniors age 65-plus and long-term care, essential workers, those with disabilities, racial and ethnic minority groups, rural populations and incarcerated and detained individuals.

The state is also preparing to procure and distribute vaccine supplies such as syringes, alcohol pads and bandages. Other pieces of the plan look at vaccine storage that requires cold conditions, data management and public education.

Average Family Premiums Rose 4% to $21,342 in 2020, Benchmark KFF Employer Health Benefit Survey Finds

2020 Employer Health Benefits Survey | KFF

Source: Kaiser Family Foundation, by Craig Palosky and Sue Ducat

Annual family premiums for employer-sponsored health insurance rose 4% to average $21,342 this year, according to the 2020 benchmark KFF Employer Health Benefits Survey. On average, workers this year are contributing $5,588 toward the cost of family coverage, with employers paying the rest.

The survey was conducted from January to July as the COVID-19 pandemic and economic crisis unfolded and may not capture its full impact on costs and coverage. The annual change in premiums is similar to the year-to-year rise in workers’ earnings (3.4%) and inflation (2.1%), though over time what employers and workers pay toward premiums continues to rise more quickly than wages and inflation. Since 2010, average family premiums have increased 55%, at least twice as fast as wages (27%) and inflation (19%).

This year 83% of covered workers have a deductible in their plan, similar to last year and up from 70% a decade ago. The average single deductible stands at $1,644 for workers who have one, similar to last year’s $1,655 average but up sharply from the $917 average of a decade ago. These two trends result in a 111% increase in the burden of deductibles across all covered workers.

“Conducted partly before the pandemic, our survey shows the burden of health costs on workers remains high, though not getting dramatically worse,” KFF President and CEO Drew Altman said. “Things may look different moving forward as employers grapple with the economic and health upheaval sparked by the pandemic.”

About 157 million Americans rely on employer-sponsored coverage, and the 22nd annual survey of nearly 1,800 small and large employers provides a detailed picture of the trends affecting it. Plan details such as premiums and deductibles largely reflect decisions made by employers before they felt the full impact of the COVID-19 pandemic and economic crisis. Next year’s survey will provide the first full look at how the pandemic may have affected workers’ health benefits.

In addition to the full report and summary of findings released today, the journal Health Affairs is publishing an article online with select findings that will also appear in its November issue. KFF is also releasing an updated interactive graphic that charts the survey’s premium trends by firm size, industry, and other firm characteristics.

The survey finds a large majority (83%) of offering employers say they are satisfied with the overall choice of providers available through their insurance plans, though significantly fewer (67%) say the same about their mental health and substance abuse networks.

About one in five (19%) describe their mental health networks as somewhat or very narrow, potentially leaving workers with limited options at a time when worry and stress related to the pandemic is affecting many working Americans.

“The coronavirus pandemic has increased the need for access to mental and behavioral health services, for which the provider networks are often more narrow than for other services,” said Gary Claxton, a KFF senior vice president and director of the Health Care Marketplace Project, the lead author of the study and Health Affairs article. “Some plans have been able to increase access by supporting telehealth, though it’s unclear whether such options will become a permanent feature.”

Other survey findings include:

* Offer rate holds steady. The survey finds 56% of employers offer health benefits, largely unchanged over the past five years. The larger an employer is, the more likely it is to offer health benefits to at least some of its workers, with about half (53%) of firms with fewer than 50 workers and nearly all (99%) firms with at least 200 or more workers offering coverage.

* Out of pocket maximums. Virtually all covered workers are in plans with a limit on in-network cost sharing (called an out-of-pocket maximum) for single coverage. Those limits vary widely, with 11% of covered workers in plans with maximums of less than $2,000 and 18% of covered workers in plans with maximums of at least $6,000.

* Wellness programs. Most large firms (81%) offer at least one type of wellness or health promotion program. Among those that offer such a program, relatively few (11%) view the programs as very effective at reducing the firm’s health care costs.


KFF conducted the annual employer survey between January and July of 2020, with about half of the interviews conducted before the full extent of the coronavirus pandemic had been felt by employers. It included 1,765 randomly selected, non-federal public and private firms with three or more employees that responded to the full survey. An additional 1,817 firms responded to a single question about offering coverage. For more information on the survey methodology, see the Survey Design and Methods Section.

CMS: Unsubsidized ACA Exchange Population Declined By 45% Over 4 Years

45% of the uninsured population is out of the ACA's reach: KFF report |  FierceHealthcare

Source: Fierce Healthcare, by Robert King

The population on the Affordable Care Act’s (ACA’s) exchanges that do not get subsidies declined by 45% from 2016 to 2019, a new report from the Trump administration found.

The report, released Friday (PDF) from the Centers for Medicare & Medicaid Services (CMS), argues that people who don’t qualify for income-based subsidies to lower the cost of insurance are being priced out of the exchanges.

“While premiums have stabilized, middle class Americans can’t afford Obamacare’s expensive premiums,” said CMS Administrator Seema Verma in a statement Friday.

A large majority of ACA enrollees get tax credits. Last year, 87% (approximately 9.3 million) of exchange enrollees who selected a plan through got an advance tax credit.

But this is the third consecutive year in a row it has been on a decline. Last year, unsubsidized enrollment dropped by more than 300,000 beneficiaries.

“From 2016 to 2019, unsubsidized enrollment declined by 2.8 million people, representing a 45-percent drop nationally,” CMS said in a release. “Though unsubsidized enrollment continues decreasing, the rate of decline dropped to 9% in 2019—down from a 20% drop in 2017 and a 24% drop in 2018.”

CMS said the lower rate of decline mirrors a relatively stable period of premiums on the exchanges.

Meanwhile, enrollment among the subsidized portion of the exchanges continues to grow.

“The subsidized portion of the market was 140% larger than the unsubsidized portion in 2019, up from 122% larger in 2018 and 61% in 2017,” the report said.

Overall, enrollment in the ACA exchanges has remained stable. Last year, an average 10.2 million individuals had paid for their coverage, a slight decline from 2018.

In Reversal, White House Approves Stricter Guidelines for Vaccine Makers

In Reversal, White House Approves Stricter Guidelines for Vaccine Makers -  The New York Times

Source: The New York Times, by Carl Zimmer and Noah Weiland

The Food and Drug Administration released new guidelines on Tuesday for coronavirus vaccine developers — a step that had been held up for two weeks by top White House officials. The guidelines make it highly unlikely that a vaccine could be authorized by Election Day.

The move, which was cleared by the White House’s Office of Management and Budget, appeared to be an abrupt reversal a day after The New York Times reported that White House officials, including Mark Meadows, the chief of staff, were blocking the guidelines. Top F.D.A. officials were caught by surprise when they learned midafternoon that the new guidelines had been cleared.

The new recommendations, which do not carry the force of law, call for gathering comprehensive safety data in the final stage of clinical trials before an emergency authorization can be granted.

On Tuesday evening, President Trump showed his displeasure at the action of his own White House, and charged that the new guidelines were a conspiracy against his re-election prospects.

“New F.D.A. Rules make it more difficult for them to speed up vaccines for approval before Election Day. Just another political hit job!” he tweeted, tagging Dr. Stephen M. Hahn, the F.D.A. commissioner.

The guidance was formally published hours after the F.D.A. had quietly released the information at the end of a document prepared for an upcoming meeting of its vaccine advisory committee.

Since the start of the coronavirus pandemic, the F.D.A. has said that it has been seeking ways to accelerate the development of vaccines without sacrificing safety. In June, the agency released an initial set of guidelines to give vaccine developers a better idea of how the F.D.A. would decide if a vaccine were acceptable, either for an emergency use authorization or for a full license.

Four vaccines have reached the final stage of testing, known as a Phase 3 trial, in the United States. A fifth is expected to start this month. Mr. Trump has repeatedly suggested that a vaccine would be ready by Election Day, if not before.

But with opinion polls showing public confidence declining about what could be a rushed coronavirus vaccine, the F.D.A. submitted a new set of guidelines to the White House for approval on Sept. 21, attempting to assure companies developing vaccines that they were being held to a common standard and to boost public confidence in the process.

Among the recommendations, the agency advised vaccine makers to follow volunteers for a median of two months after the final dose. The F.D.A. also expected vaccine makers to document five cases of severe infection in people who received the placebo instead of the vaccine.

The F.D.A. submitted the guidelines to the Office of Management and Budget for approval more than two weeks ago, but they stalled in part because of Mr. Meadows’s involvement, according to a senior administration official and others familiar with the situation.

The White House objected that the guidelines would add unnecessary burdens on vaccine makers. In a conversation with Dr. Hahn days after the guidelines were submitted, Mr. Meadows said the recommendations amounted to changing the rules on drugmakers in the throes of clinical trials, according to one senior administration official. He also suggested that Dr. Hahn was overly influenced by the career scientists who had drafted the document, the official said.

Trump administration officials have the authority to intervene with such nonbinding documents, partly because of a 2019 executive order that tightened restrictions over their issuance.

The F.D.A., however, continued to share parts of this guidance with vaccine developers in letters to the companies.

“We’ve made it clear that we want to see a median of about two months of follow-up for any of the vaccines that comes in,” Dr. Peter Marks, the F.D.A.’s top regulator for vaccines, said in an interview on YouTube on Friday.

In a statement Tuesday, the drug industry’s largest trade group, the Pharmaceutical Research and Manufacturers of America, said it supported the new guidelines.

“We have engaged with the agency to support bringing greater transparency to the review process for COVID-19 vaccines,” the statement said. “We welcome the agency’s efforts to instill confidence in the rigorous safety of these potential vaccines.”

Last Updated 10/21/2020

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