February 8, 2018
The news on Capitol Hill this week centered on the budget. A two-year budget agreement was reached in the Senate. As of this writing (2/8) the budget has not been voted into law so everything that follows could change. That said here are some key components affecting health related issues that are currently in the agreement
- Additional 4 years of CSR funding (now for 10 years total)
- 2 years of funding for Community Health Centers
- Medicare closes Part D donut hole in 2019
- Permanent repeal of limit on Medicare coverage of PT, speech-language pathology and outpatient therapy
- Repeal of IPAB
- Extension of Sequestration affecting Medicare until 2027
- Increased access for telemedicine in Medicare
- $6 billion to combat the opioid crisis
- absent was any funding for individual market stabilization (reinsurance or CSRs). If this were to happen it will be later in the year (likely March). There appears to be far more support for reinsurance funding than CSRs.
2018 Open Enrollment Closes: The last State Based Marketplace (SBM) closed open enrollment last week and the first picture of Open Enrollment is emerging. NASHP has a good picture here but SBM (states that operate their own Exchange) enrollment was flat year over year (about 3 million total enrollees). The FFM (Exchanges that the Federal government operates) saw a decline of about 5% (to about 8.3 million enrollees. SBMs had longer open enrollment periods and more advertising which likely contributed to the better enrollment performance. A more detailed picture should emerge next month when HHS releases the final Open Enrollment report. One thing to keep an eye on is the change in metal level distribution due to the CSR defunding. Early estimates have a 13% decline in Silver enrollment.
State Policies: According to the WSJ, nine different states were considering enacting their own version of the mandate to replace the Federal one that was effectively repealed starting in 2019.
The Flu: Unfortunately the worst flu outbreak in nearly a decade continues to claim lives. 53 pediatric deaths have been reported due to the flu so far this year.
Editor's note: The budget bill was passed early this morning (Feb 9, 2018).