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: New Executive Order to Impact Medicare Advantage
Executive Order on Medicare by Trump Administration
President Trump, today, issued an executive order designed to promote Medicare Advantage. The executive order was part of a speech contrasting President Trump’s approach to Medicare with potential Democratic rivals.
- According to Politico, the executive order directs CMS to promulgate regulations that would expand MA beneficiaries’ access to tax-advantaged medical savings accounts, propose ways for Medicare Advantage enrollees to receive cash rewards or rebates as a perk for saving the government money when they receive quality care.
- It also directs CMS to improve network access, reduce administrative burden, decrease the time between FDA approval and Medicare determination, if it will cover certain treatments, improve quality care and cost data (specifically shall give Medicare claims data to providers to improve quality), reduce fraud and abuse, among other things.
- Requires HHS (alongside the Council of Economic Advisors) to submit a report on ways to change Medicare FFS payments to prices paid by MA and the commercial insurance market. It also requires a report on approaches to “transition to a market-based pricing in the FFS Medicare program” (i.e., competitive bidding system/premium support).
- Finally, the order also required that CMS determine if certain practices benefit traditional Medicare at the expense of Medicare Advantage and make changes to put the programs on more level footing.
You can read the executive order here. As a reminder, Executive Orders have no force of law. In this case, depending on the issue, CMS has between 180 days and one year to propose regulations to enact the above. Many observers expect promotion of Medicare Advantage to be a theme for the Trump campaign next year for the 2020 election.
Wellness Program Demonstration for Individual Market
This week HHS released a request for applications for a health-contingent wellness program for the individual market. The program would allow states to adjust premiums or cost-sharing by up to 30% contingent on enrollees’ participation in certain activities. The ACA and HIPAA recognize three types of wellness activities: participatory, wellness, activity-only health contingent wellness, and outcome based health contingent. The waiver could either be applied wholesale to all issuers in the individual market or allow issuers the flexibility to do so if they should so choose. As part of the application process states would need to actuarially demonstrate that the changes do not result in coverage loss, higher federal costs, does not result in undue burden, cost-shifting, or is discriminatory. There is no timeline for when states can apply. You can read an excellent summary by Katie Keith here or the full CMS description here.
Short Term Insurance Survey
An excellent survey on who is signing up for short-term plans. According to healthcare.com 58% of new enrollees in short-term plans were previously uninsured. You can read more of the survey results here.
Interesting research by PwC on gene-therapy. Among the findings, current treatment access is very limited, especially for rural areas. There are currently 30 gene therapies in late-stage testing.
09/27/2019: Changes in the Employer Market
09/20/2019: Major Prescription Drug Plan Unveiled
09/06/2019: Summer’s End
08/29/2019: Pre-Labor Day Tidbits
08/16/2019: Public Charge Rule Released and Other Tidbits
08/09/2019: New Analysis on Private Markets
07/26/2019: Health Legislation Takes Center Stage
Subscribe to Wakely's newsletter and blog.