Week in Washington: Drug Bill Stalls, Open Enrollment Starts, and More

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Week in Washington: Drug Bill Stalls, Open Enrollment Starts, and More


The Hill

Several news outlets reported that President Trump officially came out against the House Prescription Drug bill. This is yet another sign that any legislation this year (and next year) is unlikely.  This includes changes to prescription drugs, Medicare, balanced billing, and health insurance tax delays.

Drug News

  • New Cystic Fibrosis Drug – The FDA approved a new drug that could treat 90% of patients with cystic fibrosis. The price of the drug is estimated at $311,000 annually. 


  • Open Enrollment for the ACA individual market kicks off November 1st for the vast majority of states. While the individual market has been remarkably stable in the past year, a number of factors are being eyed as potential head winds for the upcoming open enrollment including the potential Texas v. Azar announcement, public charge regulation, and decrease in the number of counties that have the second-lowest silver plans priced above gold plans.
  • CSR Case   A major ruling by a Federal judge on unpaid CSR payments happened this week. The judge ruled that 100 issuers were owed nearly $1.6 billion in unpaid CSRs for 2017 and 2018. This is just the latest CSR ruling to go in the issuer’s favor. The ruling is expected to be appealed to the Supreme Court.
  • Georgia Georgia released a proposed 1332 waiver. The waiver combines reinsurance, applied at a regional level, with changes to enrollment. Georgia will be no longer be using Healthcare.gov and instead have individuals only enroll through private brokers or insurance companies.


  • Work Requirements – Different states, different policy directions.
    • Nebraska released its Medicaid waiver in which it is applying to include work requirements. As opposed to previous waivers, Nebraska’s waiver would have beneficiaries be limited in their benefits (no dental or vision) if they don’t meet the work requirements.
    • Indiana will be suspending its work requirements program, pending the legal challenge.


Medigap SEP – Colorado regulators are proposing a special enrollment period in 2020 to allow any Medicare beneficiary enrolled in Plan C or F to switch to D or G without underwriting. You can read more about the SEP here.


Previous editions: 

10/18/2019: House Bills, STAR Ratings, and More

10/11/2019: Executive Actions, Public Options, and More

10/04/2019: New Executive Order to Impact Medicare Advantage

09/27/2019: Changes in the Employer Market 

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