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
While the Supreme Court will not be hearing an existential ACA case, it will hear a number of health-related cases next term. A few of the highlights include:
Medicare Hospital Reimbursement Rule on Payments involving DSH (Becerra v. Empire Health). A ruling could vacate how much hospitals receive for having more Medicaid/uninsured individuals.
Medicaid Payments – The court will review whether a state Medicaid program can claim tort settlements for past medical expenses
Abortion Case- The Supreme Court will hear a case that could have large implications for abortion (Dobbs v. Jackson)
Medicare and Drug Co-Pay
According to Axios, a federal judge is expected to rule whether Pfizer can pay Medicare patients’ out-of-pocket expenses. Currently, drug companies are banned from directly or indirectly pay for drug copays. However, Pfizer is suing to cover those costs. If Pfizer wins, other companies are expected to follow suit, which ultimately could increase health care spending. Whoever wins, an appeal would be expected, which could delay when the ruling would go into effect.
Congress is expected to make a push over the next two weeks to finalize an infrastructure bill. It’s unclear the timeline for the reconciliation package that includes health care items, but there is likely also a push to finalize soon thereafter.
CMS announced that Meena Seshamani was appointed to the role of Director of the Center of Medicare (CM). Dr. Seshamani has a history of being involved in value-based payments, and her selection could signal that CM will focus on that in the future.
A new rule implementing a Most Favored Nation model as a way to reduce Medicare Part B drugs is expected to be releasd soon.
The CDC announced that the COVID Delta Variant has become the dominant variant in the US. Several states with low vaccination rates, notably Arkansas and Missouri, have seen large increases in hospitalizations. As the NYTimes shows below, there remains a large variation in vaccination rates and cases, with a direct correlation between the two.
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