October 5, 2018
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On the health policy front Congress/Executive has been generally quiet. The major piece of news is that the Opioid Bill passed the Senate and heads to the President’s desk where it’s expected to be passed into law. The law, among other things, will increase Medicare payments for telemedicine, mandate e-prescription for controlled substances in Part D, and change the IMD exclusion rule for Medicaid.
CMS announced that the quality rating System (QRS) pilot, which provides quality information for Exchange plans, wll be published for 5 states (Virginia, Wisconsin, Michigan, Montana, and New Hampshire). Enrollees in these 5 states can use quality information when making their 2019 plan selection decisions.
Politico is reporting that the pharmaceutical industry will aim for the lame duck session of Congress (November-December) to implement changes to the Part D doughnut hole. The crux of the issue is that under the bipartisan budget bill, drugmakers had to offer more discounts in the coverage gap (i.e., doughnut hole). Pharma is pushing to reverse these changes and will attempt to do it as part of bills moving after the election.
- Family Foundation released its annual Employer Health Benefits Survey. The survey is one of best collections of data on the Employer-sponsored insurance market, especially as its annual nature allows for impressive longitudinal analysis. KFF found that premiums increased on average 3% for single premiums and 5% for family premiums. Average annual premiums for ESI coverage reached $19,616. There were no changes in percentage of firms self-funding, and the percentage of firms offering coverage increased from 2017 to 2018. Give the survey a read…
Health Affairs Articles
Health Affairs released a slew of interesting articles
- Gusmano et al found that Medicare Beneficiaries living in housing with supportive social services had hospital discharge rates 32% lower, hospital lengths 1 day short, and ACSC rates 30% lower.
- Zallman et al found that immigrants account for 12.6% of premiums paid by private insurers but only make up 9.1% of insurer expenditures.
- Griffith et al examined the factors that correlated with insurer choices to participate in markets. Medicaid expansion, profitability, and county demographics all played a role according to the authors.