Week in Washington 21121

Week in Washington is brought to you by Michael Cohen, PhD. Tune in each week to read the latest on healthcare policy and get a glimpse of what’s on the horizon.

Week in Washington

2/11/2021

Congress

The big health policy news was that several committees in the House of Representatives (Ways and Means as well as Energy and Commerce) released language surrounding the potential COVID Relief Bill supported by President Biden. The bill is generally targeted around COVID funds (vaccines, testing, etc.) and economic support (unemployment insurance, child tax credits, etc.), but there are a number of important (albeit temporary) health care items. These include:

ACA Items

• Increased amounts and eligibility for premium tax credits for 2021 and 2022. For example, for the first time, those under 150% FPL would receive sufficient subsidies to cover the entire premium. Also, those above 400% FPL would be eligible for subsidies for the first time
• Those that receive or are eligible to receive unemployment reinsurance would be eligible for subsidies in 2021.
• Hiatus of tax reconciliation of the advanced premium tax credits (tax year 2020)

Medicaid Items

• Expands the coverage of COVID vaccines for Medicaid beneficiaries and provides 100% FMAP for vaccine coverage for one year after the end of the public health emergency
• Effective January 1, 2023, the bill would eliminate 100% of the AMP cap on drug rebates
• Offers incentives for states to expand their Medicaid program (if newly expand, get an additional five percentage point. increase in regular matching for two years)
• Gives states the option to extend postpartum coverage for new mothers for one year (current limit 60 days). Option available for five years

Next Steps

The House is expected to finalize the draft language in the next week or two and then vote on the bill. If it passes, it will then go to the Senate, who have the choice to approve or change the bill (if the bill is changed, it will go back to the House for a final vote). The goal of House and Senate Democrats is for the bill to be passed before unemployment insurance increases expire on March 14.

COVID

COVID cases, hospitalization, and deaths all decreased in the past week. The seven day average of new cases, for example, fell 22.8%. Vaccine distribution continues to increase, with about 10.7% of the US population receiving at least one dose of a COVID vaccine. Dr. Fauci announced that the Federal government expected COVID vaccines to be open to the general public sometime in April.

While the news was generally positive, there were some negative COVID stories. For example, South Africa had to suspend the distribution of the AstraZeneca vaccines because initial results were showing it ineffective against a new COVID strain. More generally, several stories appeared in which some epidemiologists have shifted to a view that while the crisis phase of the COVID pandemic may end by the end of the year, there is an increased likelihood that the virus will be endemic.

ACA

Starting February 15, all but one (Idaho) Exchange will be open for a COVID-related Special Enrollment Period (easier than normal).

Research You Can Use

• The CDC released new research that found that double masking (i.e., cloth and surgical mask) could reduce COVID transmission by up to 96.5%.
• Amitabh Chandra et al. did in-depth research on the impact of cost-sharing on Medicare prescription drug usage. They found that “we show that an as-if-random increase of 33.6% in out-of-pocket price (11.0 percentage points (p.p.) change in coinsurance, or $10.40 per drug) causes a 22.6% drop in total drug consumption ($61.20) and a 32.7% increase in monthly mortality (0.048 p.p.).” The mortality effects were traced back to a reduction in drugs like statins and antihypertensives. Overall there was no evidence that reductions in utilization due to increased cost-sharing affected only “low-value drugs.”

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