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Health plans - policy


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Administration Plans to Require Hospitals to List 'Shoppable' Prices
"Hospitals could be required to provide prices in an 'easy-to-read, patient-friendly format' before they provide services to patients under rules that will be proposed in an executive order signed by President Donald Trump.... [HHS] Secretary Alex Azar said the order would 'put American patients in control and address the fundamental drivers of high American healthcare costs.' " (FierceHealthcare)
New Executive Order May Make More Health Care Prices Public
"The White House will release an executive order Monday afternoon intended to require insurance companies, doctors and hospitals to give patients more information about precisely what their care will cost before they get it.... Exactly what information hospitals and insurers will have to disclose is not specified in the executive order ... White House officials said the details would be worked out during the rule-making process. Hospitals and insurance companies are likely to lobby to make any disclosures as general as possible." (The New York Times; subscription may be required)
U.S. Supreme Court Takes Up Insurers' $12 Billion Obamacare Dispute
"The U.S. Supreme Court on Monday agreed to decide whether the federal government must pay insurers $12 billion under an Obamacare program aimed at encouraging them to cover previously uninsured people after the healthcare law was enacted in 2010. The justices will hear an appeal by a group of insurers of a lower court ruling that Congress had suspended the government's obligation to make the payments. The insurers have argued that the ruling would allow the government to pull a 'bait-and-switch' and withhold money they were promised." [Maine Community Health Options v. U.S., Nos. 17-2395 (Fed. Cir. Jul. 9, 2018; cert. granted Jun. 24, 2019)] (Reuters)
[Opinion] Non-English Speakers Would Be Disadvantaged by Trump Administration Plan to Ease Language Rules on Health Notices
"The government acknowledged in the proposal that the change would lead to fewer people with limited English skills accessing health care and fewer reports of discrimination. But it also questioned the need for these notices, pointing out that in some areas health organizations spend money to accommodate a small contingent of language speakers. For example, notices in Wyoming must account for the 40 Gujarati speakers -- a language of India -- in the state." (Kaiser Health News)
[Opinion] New Rule Could Mean Consumer Confusion, Higher Premiums in Marketplace
"The rule will almost certainly raise marketplace premiums because HRAs will be more attractive to firms with sicker-than-average employees.... The rule has guardrails designed to prevent that from occurring, but employers may still find ways to target sicker workers.... Employees will need to do considerably more work to enroll in an individual market plan than an employer's group plan.... The new rules will likely expand enrollment in short-term plans[.]" (Center on Budget and Policy Priorities)
[Guidance Overview] Health Care-Related Expiring Provisions of the 116th Congress, First Session
44 pages. "This report describes selected health care-related provisions that are scheduled to expire during the first session of the116th Congress (i.e., during calendar year 2019).... This report generally focuses on two types of health care-related provisions ... The first type of provision provides or controls mandatory spending, meaning that it provides temporary funding, temporary increases or decreases in funding ... or temporary special protections that may result in changes in funding levels ... The second type of provision defines the authority of government agencies or other entities to act, usually by authorizing a policy, project, or activity. Such provisions also may temporarily delay the implementation of a regulation, requirement, or deadline, or establish a moratorium on a particular activity." [Report R45781, June 21, 2019] (Congressional Research Service [CRS])
President Trump to Issue Executive Order on Health Care Price Transparency
"The order will direct federal agencies to initiate regulations and guidance that could require insurers, doctors, hospitals and others in the industry to provide information about the negotiated and often discounted cost of care ... Consumers and employers will benefit because pulling back the secrecy around the prices will allow them to shop for lower cost care and benefits, advocates say. But industry groups including hospitals and insurers have balked at the idea, saying it could cause costs to climb if some businesses learn competitors are getting bigger discounts." (The Wall Street Journal; subscription may be required)
Senate HELP Committee Hearing: Lower Health Care Costs Act
June 18 hearing on Draft Bill. Page includes video of hearing along with links to testimony by: [1] Sean Cavanaugh, Aledade; [2] Benedic N. Ippolito, American Enterprise Institute; [3] Elizabeth Mitchell, Pacific Business Group on Health; [4] Tom Nickels, American Hospital Association; [5] Frederick Isasi, Families USA; [6] Marilyn Bartlett, Office of the Montana State Auditor. (Committee on Health, Education, Labor and Pensions, U.S. Senate)
IRS 2018-2019 Priority Guidance Plan, Third Quarter Update (PDF)
37 pages. Updated March 31, 2019; released June 17, 2019. Employee benefits items begin on page 14. (Internal Revenue Service [IRS])
[Opinion] The Cadillac Tax: It's Time To Kill This Policy Zombie
"[P]olicy makers should incentivize employers to strengthen rather than cut their support for workers' and dependents' health insurance. Lawmakers increasingly realize the need to change direction, as suggested by the bipartisan majority of House members and more than a third of the country's senators who are now co-sponsoring 2019 legislation that would repeal the Cadillac tax. Abundant evidence shows the need for this change." (Stan Dorn, in Health Affairs)
Takeaways from Congress's Latest Single-Payer Hearing
"[1] The hearing was supposed to address various legislative proposals that would expand coverage ... [but] the debate centered almost entirely on the Medicare for All Act.... [2] The fate of the ACA remains unknown.... [3] Potential for adverse effects on provider rates draws concerns.... [4] Cost of a single-payer system remains unknown." (Healthcare Financial Management Association [HFMA])
[Opinion] Are You Sure You Actually 'Like' Your Private Health Insurance?
"Four in ten Americans with employer-sponsored health insurance say their family is struggling to pay premiums, medical bills, or out-of-pocket medical costs. Half of us have a family member who is avoiding necessary medical care or prescriptions because of cost.... Thousands of physicians, medical students, nurses, and our colleagues across health care ... are joining the Medicare for All movement because we want our work to be about protecting people's health, not destroying their wealth." (CommonDreams.org)
[Opinion] The Trump Administration's Newest Health Care Rule
"A broad shift to HRAs could resemble the movement in retirement benefits from defined benefit pensions to 401(k) plans, where employers make fixed contributions instead of promising a set benefit for years in the future. A similar change in health coverage would give businesses more predictable costs while shifting the risk of higher healthcare expenses onto workers. It's all about money and determining or deflecting risk." (Business Forward)
States Continue to Make Efforts to Lower Health Care Prices Paid by Private Insurers
"States, which can often legislate more rapidly and with more flexibility than the federal government, can thus serve as important laboratories to inform federal action. [This article discusses] approaches states are taking: [1] targeted price regulation, [2] promoting competition, and [3] investing in alternative payment models." (The JAMA Network)
Disclosure Rules May Be Coming for Health Plans
"A bipartisan bill called the Lower Health Care Costs Act ... addresses surprise medical bills ... [and improves] transparency to ensure that pharmacy benefit managers pass along drug discounts to customers.... [D]eep inside the bill, on page 111, are new sweeping ... and onerous commission disclosure provisions.... [B]rokers would have to disclose their compensation, in writing, at the time an employer signs up for benefits, regardless of how large the employer is. Failure to comply might ultimately result in the employer being required to terminate its carrier or broker relationship.... Disclosure is also required anytime an employee makes written request for it." (ERISAPros)
House Energy and Commerce Committee Hearing: No More Surprises -- Protecting Patients from Surprise Medical Bills
Page includes video of the hearing, along with Memorandum from Chairman Pallone to the Subcommittee on Health, opening statement from Chairman Pallone, and opening statement of Subcommittee Chair Eshoo, along with testimony from: [1] Sonji Wilkes, Patient Advocate; [2] Sherif Zaafran, MD, FASA, Physicians for Fair Coverage; [3] Rick Sherlock, Association of Air Medical Services; [4] James Gelfand, The ERISA Industry Committee; [5] Thomas Nickels, American Hospital Association; [6] Jeanette Thornton, America's Health Insurance Plans; [7] Claire McAndrew, Families USA; and [8] Vidor E. Friedman, MD, FACEP, American College of Emergency Physicians. (Energy & Commerce Committee, U.S. House of Representatives)
2019 Scorecard on State Health System Performance
"[M]ost states are losing ground on key measures related to life expectancy as premature deaths from suicide, alcohol, and drug overdose continue to increase. Several states that most recently expanded eligibility for their Medicaid programs saw meaningful gains in access to health care; in other states prior gains eroded between 2016 and 2017." (The Commonwealth Fund)
Improving the Accuracy of Health Plan Provider Directories
"[A] study compared the accuracy of four sources of provider information from five U.S. counties ... Extensive inaccuracies were found across all four sources of information. The inaccuracy rate for phone numbers ... ranged from 25 percent to 48 percent. Insurance carriers offering both MA and ACA exchanges did not report the same addresses 31 percent of the time.... In addition to incentivizing health plans to adopt machine-readable directories, federal policymakers should consider establishing a federal 'source of truth' for provider information, perhaps by revamping the Medicare National Plan and Provider Enumeration System (NPPES) file." (The Commonwealth Fund)
[Opinion] Gruber and Sommers Tell What We've Learned from 10 Years of ACA
"The authors tell us that we need ongoing studies of potential solutions such as 'a public option on the insurance marketplace, moving more Medicaid beneficiaries to private coverage, and -- most dramatically -- 'Medicare-for-All' in various configurations.' So just what studies do we need?" (Physicians for a National Health Program [PNHP])
Association Health Plans Work for Cannabis Companies
"[A recent article] discussed the difficulties of Cannabis, Hemp, and CBD companies in affording their employees 401(k) plan access. These companies confront the same difficulty in accessing health benefits for their employees. Unequivocally, Cannabis, Hemp, and CBD companies (and thus their employees) are entitled to participate in AHPs." (FisherBroyles LLP, via Lexology; free registration required)
District Court Orders Nationwide Injunction: Contraceptive Mandate Under ACA Cannot Be Enforced
"On June 5, 2019, Judge Reed O'Connor of the Northern District of Texas issued a permanent injunction against the [ACA's] contraceptive mandate. The court found that the contraceptive mandate and the Obama-era accommodations process for religious entities violate the Religious Freedom Restoration Act (RFRA) and can no longer be enforced by the federal government against those who object to contraceptive coverage. This means that entities and individuals covered by Judge O'Connor's decision are fully exempt from the contraceptive mandate." [Deotte v. Azar, No. 18-825 (N.D. Tex. June 5, 2019)] (Katie Keith, in Health Affairs)
The ACA's Effects on Patients, Providers and the Economy: What We've Learned So Far
"[The authors] find strong evidence that the ACA's provisions have increased insurance coverage. There is also a clearly positive effect on access to and consumption of health care, with suggestive but more limited evidence on improved health outcomes. There is no evidence of significant reductions in provider access, changes in labor supply, or increased budgetary pressures on state governments, and the law's total federal cost through 2018 has been less than predicted." (Jonathan Gruber and Benjamin D. Sommers, for National Bureau of Economic Research [NBER]; purchase required for full document)
Congress Focuses on Surprise Billing: A Summary of Three Bipartisan Proposals
"[This article] provides a high-level summary of three bipartisan proposals addressing the issue of surprise medical bills: [1] A discussion draft of the No Surprises Act, released on May 13, 2019... [2] The Stopping the Outrageous Practice (STOP) of Surprise Medical Bills Act of 2019 (S. 1531) ... [3] A discussion draft of the Lower Health Care Costs Act of 2019, released on May 23, 2019[.]" (Alston & Bird)
[Opinion] American Academy of Actuaries Comments to House Ways and Means Committee on Expanding Access to Public Insurance Plans (PDF)
33 pages. "Proposals to expand access to public health insurance plans are being put forward to provide a way to supplement efforts to strengthen insurance markets under the [ACA] or to replace the ACA marketplaces and/or other health insurance programs altogether.... This issue paper ... outlines four approaches aiming to achieve such goals and highlights the key design elements that would need to be specified for an approach to be fully evaluated and implemented." (Health Practice Council, American Academy of Actuaries)
New State Waiver Applications, Risk Adjustment Data
"On May 31, 2019, CMS issued risk adjustment data validation (RADV) results for the 2017 plan year and finalized a new change to the risk adjustment holdback policy for 2018 and beyond. On June 5, CMS informed Colorado and North Dakota that their applications for state-based reinsurance programs under Section 1332 of the [ACA] were complete. Comments on those waiver applications can be made through July 5." (Katie Keith, in Health Affairs)
[Opinion] Surprise Billing: No Surprise in View of Network Complexity
"[T]he current debate has largely missed two other important problems related to provider networks: inaccurate provider directories and inadequate provider networks. These problems are inherently complex, harder to turn into news stories, and defy simple solutions. Yet, they also affect a much larger number of Americans' financial and physical well-being than does surprise billing." (Simon F. Haeder, David L. Weimer, and Dana B. Mukamel, in Health Affairs)
[Official Guidance] ERISA Advisory Council to Meet June 25-27
"[The next meeting of] the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on June 25-27, 2019 ... to hear testimony from invited witnesses and to receive an update from [EBSA].... The Advisory Council will study the following topics: [1] Beyond Plan Audit Compliance: Improving the Financial Statement Audit Process ... and [2] Permissive Transfers of Uncashed Checks from ERISA Plans to State Unclaimed Property Funds[.]" (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
Why State Healthcare Individual Mandates are Becoming More Popular
"So far, Massachusetts, New Jersey, the District of Columbia and Vermont have passed individual mandates. Penalties vary and may change yearly, but can be range from a couple hundred dollars to $1500.... Many states that filed an appeal against the ruling that the ACA is unconstitutional are considering adding a healthcare individual mandate. Hawaii, California, Washington, Connecticut, Rhode Island and Minnesota are discussing their own versions of this new law." (Tango Health)
Witnesses Testify in Review of CVS-Aetna Merger
"The nearly $70 billion transaction closed last fall, but [Judge Richard Leon of the U.S. district court for the District of Columbia] has been thoroughly scrutinizing the DOJ-approved deal.... This isn't a trial; it's merely an opportunity for Leon to gather additional perspective on the acquisition as part of his Tunney Act review process.... The hearings will last up to three days, with three witnesses put forward by amici curiae expected to speak first, followed by three witnesses put forward by CVS and the DOJ." (HealthLeaders Media)
New York and New Jersey Consider Health Insurance Reforms
"New Jersey lawmakers have introduced a slew of additional health insurance reform bills that would further defend the state-based health care plans and marketplace ... With these bills, New Jersey is working to create a comprehensive scheme of laws and regulations that will govern a state-based health care program. New York has also recently taken steps toward health insurance reform." (Pepper Hamilton LLP)
California Gov. Newsom Proposes Penalty to Fund Health Insurance Subsidies
"Under a proposal by Gov. Gavin Newsom, an estimated 850,000 Californians could get help paying their premiums, including people like Haas and Snyder, who together make too much to qualify for federal financial aid but still have trouble affording coverage. To pay for the health insurance tax credits, the Democratic governor is proposing a tax penalty on Californians who don't have health insurance -- similar to the unpopular federal penalty the Republican-controlled Congress eliminated, effective this year." (Kaiser Health News)
Law Professors Ask SCOTUS to Limit 'Forum Selection' Plan Provisions
"Eleven law professors called on the U.S. Supreme Court to rule that companies can't unilaterally limit the courts in which workers can sue over their health and retirement benefits.... The Supreme Court expressed interest in the issue in 2016, after the Sixth Circuit became the first appeals court to hold that forum selection clauses are permissible under ERISA.... Since then, the Third, Seventh, and Eighth circuits all followed the Sixth Circuit's lead in upholding these clauses from ERISA challenges." (Bloomberg Law)
Policy Options to Help Self-Insured Employers Improve PBM Contracting Efficiency
"The Lower Health Care Costs Act ... includes three key components that address PBM contracting inefficiencies for self-insured employers. [1] PBMs would be mandated to report to employers drug-specific and aggregated pricing, utilization, and spending details for all drugs they contract for on behalf of employers ... [2] PBMs would be prohibited from practicing 'spread pricing' ... [3] PBMs would be mandated to pass-through all price concessions to employers, including rebates, fees, alternative discounts, and other remunerations received from drug companies." (Ge Bai, Mariana P. Socal, and Gerard F. Anderson, in Health Affairs)
Bill Would Require Health Benefit Brokers to Disclose Compensation
"The Lower Health Care Costs Act was introduced by Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash. The bill takes aim at a number of issues, including surprise medical bills, high drug prices and public health problems. The bill also would create more transparency around pharmacy benefit managers to ensure they are passing along discounts on drugs to customers." (InsuranceNewsNet.com)
[Guidance Overview] HHS Proposes to Strip Gender Identity, Language Access Protections from ACA Anti-Discrimination Rule
"The proposed rule would entirely eliminate: [1] The definitions section of the current rule ... [2] Specific nondiscrimination protections based on sex, gender identity, and association; [3] Major language access requirements ... [4] Notice requirements that require covered entities to post information about Section 1557 and nondiscrimination at its locations and on its website; [5] Requirements to have a compliance coordinator and written grievance procedure to handle complaints about alleged violations of Section; and [6] Various enforcement-related provisions [.]" (Katie Keith, in Health Affairs)
Supreme Court Could Soon Consider Several ERISA Cases
"The cases include examples of 'stock drop' litigation; litigation about the burden of proof to establish loss; a case that tests the 'actual knowledge' standard for statute of limitations purposes; and a case that examines pleading standards under ERISA." (planadviser)
Administration Preparing Executive Order on Health-Cost Disclosure
"President Trump is expected to release an executive order as early as next week to mandate the disclosure of prices in the health-care industry ... The order could direct federal agencies to pursue actions to force a host of players in the industry to divulge cost data ... The administration is also looking at using agencies such as the Justice Department to tackle regional monopolies of hospitals and health-insurance plans over concerns they are driving up the cost of care[.]" (The Wall Street Journal; subscription may be required)
ACA Litigation Round-Up
"ACA challenges are now under consideration by the Supreme Court and federal appellate and district courts across the country. This post provides a status update on ongoing litigation over the risk corridors program, cost-sharing reductions, the risk adjustment program, association health plans, and short-term plans." (Katie Keith, in Health Affairs)
Public Health Insurance Legislation Announced in Connecticut
"[The proposed bill would] create a public option that will allow individuals and small businesses to purchase health insurance through the state. The proposal also calls for re-establishing the individual mandate ... The bill would also have the state seek permission from the federal government to buy prescription drugs from Canada and calls for taxing opioid manufacturers." (The Wall Street Journal; subscription may be required)
ACA Litigation Round-Up: Contraceptive Coverage Mandate
"With the final rules enjoined, the Obama-era accommodation for the contraceptive mandate remains in place. Given this, two couples and a business in Texas brought a class action lawsuit to challenge the Obama-era rules. This lawsuit is advancing quickly and could lead to a situation where both the Obama-era rules and the Trump-era rules on the contraceptive mandate are set aside in dueling preliminary injunctions. This post summarizes the current status of the litigation in California, Massachusetts, Pennsylvania, and Texas." (Katie Keith, in Health Affairs)
CBO Testimony to House Budget Committee on Key Design Components and Considerations for Establishing a Single-Payer Health Care System
"CBO conveyed two main points in its testimony: First, moving to a single-payer system would be a major undertaking. It would involve significant changes for all participants--individuals, providers, insurers, employers, and manufacturers of drugs and medical devices. Because health care spending currently accounts for about one-sixth of the nation's economic activity, those changes could significantly affect the overall U.S. economy. And the transition toward a single-payer system could be complicated, challenging, and potentially disruptive. Second, to establish a single-payer system, lawmakers would need to make many decisions and would face complex trade-offs." (Congressional Budget Office [CBO])
House Ways and Means Committee Hearing: Protecting Patients from Surprise Medical Bills
May 21 hearing. Testimony from: [1] The Honorable Katie Porter (D-CA); [2] The Honorable Cathy McMorris Rogers (R-WA); [3] James Patrick Gelfand, ERISA Industry Committee (ERIC); [4] Tom Nickels, American Hospital Association (AHA); [5] Jeanette Thornton, America's Health Insurance Plans (AHIP); [6] Dr. Bobby Mukkamala, American Medical Association (AMA). (Committee on Ways and Means, U.S. House of Representatives)
Oklahoma Governor Signs Law Regulating PBMs
"Oklahoma Gov. Kevin Stitt ... signed into law HB 2632, which protects patient access to pharmacy services by establishing network adequacy and 'any willing pharmacy' requirements, minimizes pharmacy benefit manager conflicts of interest by prohibiting higher reimbursement rates for PBM-owned pharmacies, and limits PBM abuses by prohibiting retroactive claim adjustments and denials." (National Community Pharmacists Association [NCPA])
Breaking Down the Bipartisan Senate Group's New Proposal to Address Surprise Billing
"[A] bipartisan group of senators [has] released new legislation to address surprise medical bills ... by prohibiting balance billing for categories of services where surprise bills commonly arise and prescribing an initial payment from insurers tied to median in-network rates, with the option for providers or insurers to initiate an arbitration process to challenge this rate. By tying automatic payment to the insurer's median in-network rate ... the [STOP Surprise Medical Bills Act] could reduce health care costs as well, although the existence of arbitration as a backstop makes that uncertain." (Health Affairs)
Fact Check: Did the ACA Create Preexisting Condition Protections for People in Employer Plans?
"Protections for preexisting conditions for most people with job-based insurance predated the ACA by more than a decade.... [T]he principal purpose of [HIPAA] was to put an end to what was known as 'job lock.' That happened when people with preexisting health conditions were afraid to leave one job with insurance for another job with insurance because the new insurance would not cover their condition, or would impose long waiting periods.... Most of the states had already attempted to address the job-lock problem by the mid-1990s, but states could not reach the majority of the population with health insurance because they were covered by [ERISA]." (Kaiser Health News)
District Court Issues Permanent Injunction and Bars ACA Employer Mandate Penalties
"The court declared that the plaintiffs may comply with the ACA by offering health plans that exclude coverage for abortion-causing drugs, devices, and procedures (and related education and counseling) but that are otherwise compliant. The court also barred the Departments from imposing penalties against the plaintiffs under the ACA's employer mandate and numerous other group health plan compliance requirements regarding coverage of abortifacients." [Christian Employers Alliance v. Azar, No. 16-309 (D.N.D. May 15, 2019)] (Thomson Reuters Practical Law)
[Opinion] End Surprise Billing in Healthcare, But Do It Carefully
"An appropriate solution should reflect the geographic differences in the cost of services, consider the rates established by the private market for these services, and increase predictability for employer plan sponsors.... The U.S. Chamber's recommended solution is to create a benchmark that allows issuers to reimburse facility-based [Emergency room physicians, Radiologists, Anesthesiologists, and Pathologists (ERAP) doctors] for out-of-network services based on the median in-network reimbursement for that same service." (U.S. Chamber of Commerce)
Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029
12 presentation slides. "In an average month for each year during that period, between 240 million and 242 million such people are projected to have health insurance, mostly from employment-based plans.... Net federal subsidies for insured people will total $737 billion in 2019 ... That annual sum is projected to reach $1.3 trillion in 2029.... Medicaid and the Children's Health Insurance Program account for between 40 percent and 45 percent of the federal subsidies, as do subsidies in the form of tax benefits for work-related insurance." (Congressional Budget Office [CBO])
House Passes Legislation to Strengthen the ACA
"[T]he Strengthening Health Care and Lowering Prescription Drug Costs Act ... combines four individual bills related to the ACA and three bills to lower prescription drug costs.... The bill was also amended to require increased transparency of ACA-related activities by [HHS], to prohibit HHS from ending automatic reenrollment in marketplace plans, and to express the sense of Congress that HHS should not limit the practice of silver loading." (Katie Keith, in Health Affairs)
Washington Becomes First State to Create Public Option Health Insurance
"Washington's law creates a hybrid system ... in which private insurance carriers will offer three levels of state-defined plans.... [T]he state will define the plans' terms but will not provide the plans itself; rather, it will hire private insurance carriers to administer the plans, including enrolling patients and paying out claims." (Pepper Hamilton LLP)
[Guidance Overview] DOL Issues Additional Guidance on AHPs
"The guidance confirms that AHPs operating under the new rule cannot market to or enroll new members and that existing AHPs (that predated the latest rule) can continue to operate. In the meantime, the Trump administration has appealed the court's decision to the Court of Appeals for the District of Columbia." (Katie Keith, in Health Affairs)
[Opinion] Amicus Brief of ACLJ to Fifth Circuit Addressing Constitutionality of ACA After Repeal of Individual Mandate (PDF)
"The individual mandate no longer functions as a tax and cannot be sustained as a constitutional exercise of Congress's power to tax.... A decision from this Court holding the individual mandate unconstitutional is consistent with the Supreme Court's NFIB decision and does not trench upon the Supreme Court's prerogative to overrule its own decisions." [Texas v. Azar, No. 19-10011 (5th Cir. amicus brief filed May 10, 2019)] (American Center for Law and Justice [ACLJ])
Bipartisan Consensus on Surprise Medical Billing, but Finding an Effective Fix May be Difficult
"[E]ven with bipartisan recognition of the problem, crafting a federal solution is expected to be complex. In addition to determining how to balance state and federal roles in regulation of insurance practices, it will be important for legislators to understand how reimbursement rates are set in the private sector, how charges may differ from actual costs, the complicated dynamics of negotiations between payers and hospital-based physicians, and the role cost shifting continues to play in the health care system as a whole." (Reed Smith)
Lawsuit Against Generic Drug Manufacturers Alleges Conspiracy to Fix Prices for Over 100 Drugs
"[Connecticut] Attorney General William Tong led a 44-state coalition in announcing a lawsuit against Teva Pharmaceuticals and 19 of the nation's largest generic drug manufacturers alleging a broad conspiracy to artificially inflate and manipulate prices, reduce competition and unreasonably restrain trade for more than 100 different generic drugs.... The drugs at issue account for billions of dollars of sales in the United States, and the alleged schemes increased prices affecting the health insurance market, taxpayer-funded healthcare programs like Medicare and Medicaid, and individuals who must pay artificially-inflated prices for their prescriptions drugs." [Connecticut v. Teva, No. 19-710 (D. Conn. complaint filed May 10, 2019)] (Office of Connecticut Attorney General William Tong)
Fixing Out-of-Network Bills Means Someone Must Pay
"Insurers and health care providers each oppose the other side's preferred solution to end surprise bills. That conflict makes it almost impossible for lawmakers to come up with a fix that won't leave one of the influential groups unhappy." (Kaiser Health News)
White House Announces Principles to Address Surprise Billing in Healthcare
"In emergency situations, balance billing for amounts above the in-network allowed amount should be prohibited.... Before scheduling their care, patients should be given information about whether the care providers are out of their network and what related costs that may bring." (The White House)
House Subcommittee Hearing: Lowering Prescription Drug Prices -- Deconstructing the Drug Supply Chain
May 9 hearing. Page includes video of hearing, along with Memorandum from Chairman Pallone and testimony from witnesses: [1] Justin McCarthy, Pfizer; [2] Kave Niksefat, Amgen; [3] Jeffrey Hessekiel, Exelixis; [4] Amy Bricker, Express Scripts; [5] Brent Eberle, Navitus Health Solutions; [6] Estay Greene, Blue Cross and Blue Shield North Carolina; [7] Lynn Eschenbacher, Ascension; [8] Jack Resneck, M.D., American Medical Association; [9] Richard Ashworth, Walgreen Co.; [10] Leigh Purvis, AARP. (Energy & Commerce Committee, U.S. House of Representatives)
District Court Invalidates Labor Department's 2018 Final Association Health Plan Rule (PDF)
"[O]ne need not stray at all from the decision' s text to discern a powerful and ringing endorsement of the prior law ERISA rules governing bona fide associations ... The opinion enunciates clearly what those standards are (purpose, commonality of interest, and control), holds them up as exemplars, and finds the new rules wanting by comparison.... This has important ramifications for those state regulators who, in the wake of the issuance of the Final Rule, issued guidance categorically rejecting any large group AHPs." [State of New York v. U.S. Dept. of Labor, No. 18-1747 (D.D.C. Mar. 28, 2019; notice of appeal filed by DOL on Apr. 26, 2019)] (Mintz, via Bloomberg Tax Management Compensation Planning Journal)
Update to Texas v. United States: DOJ Files a Brief in Support of Eliminating the ACA
"The Brief explains that after further review of the district court's opinion, the United States now takes the position that the provisions of the ACA are 'highly interdependent' and that they 'would not 'function in a coherent way and as Congress would have intended' in the absence of the individual mandate and the guaranteed-issue and community-rating provisions.' As such, the individual mandate is inseverable from the rest of the ACA and the entire ACA should be struck down." (Sheppard Mullin)
[Opinion] American Academy of Actuaries Comment Letter to CMS About Sale of Individual Health Insurance Coverage Across State Lines (PDF)
"The impact of allowing cross-state insurance sales on the number of insurance plans available to consumers and the cost of coverage depends on how these plans are regulated and whether other changes are made to insurance market rules." (American Academy of Actuaries)
 
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