Week in Washington: Uninsured Data, E-Cigarettes and Congress Returns

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: Uninsured Data, E-Cigarettes and Congress Returns

The major health policy news this week was the release of the Census’ view of the uninsured data.

You can read the full report here but a few things to flag:

• In 2018, 8.5% of people, or 27.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9% or 25.6 million). This is the first year-to-year increase in the percent of uninsured since 2008-2009.
• The change was primarily driven by a decrease in Medicaid coverage. Between 2017 and 2018, the percentage of people covered by Medicaid decreased by 0.7 percentage points to 17.9%.
• These two trends were related as children were among the largest cohort to experience a decrease in Medicaid coverage and an increase in the uninsured rate.
• Employer-Sponsored Coverage did not exhibit a statistical change (if anything it is more likely than not to have decreased). In other words, despite the strong job market, coverage did not increase.
• Increases in the uninsured rate were more prominent in Southern states and states that did not expand Medicaid.

Regulatory Watch

• The largest regulatory change this week was announcement that the Trump Administration would be moving to ban flavored e-cigarettes. The move occurred after several teenage deaths were reported in the news. There is currently legislation that could move that would put further curbs on vaping as well increase the age for tobacco use to 21.

Legislation Watch

• Nancy Pelosi’s long rumored drug price legislation leaked this week. The plan, as being reported, would grant Medicare significant authorities to negotiate with drug makers with a goal of reducing prices. Several Republican Senators expressed interest in giving CMS negotiating powers but it remains unclear when Pelosi may officially introduce the bill or how much support it may have in the Senate.

Judicial Watch

• Health Affairs’ Katie Keith flagged this week that while the IRS released information on the Health Insurance Tax there is ongoing litigation on this issue.  In June a District Court Judge ruled that, “the Federal regulation unlawfully required the states to account for and pay the HIT in their Medicaid and CHIP managed care organization (MCO) capitation rates.” The case is currently under appeal but is worth monitoring.

Other Stuff

• KFF released a report on estimated MLR payments this year. Based on their analysis, the insurance industry is expected to pay out $1.3 billion in rebates. The lion-share of the amount is due to rebates owed for the individual market ($743 million). The large rebates are further evidence of the increased profitability of the individual market. One note is that MLR rebates are calculated on a three-year average so rebates could be even higher next year once the less profitable years are dropped from the calculation.

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