Week In Washington: New Stats Paint Grim Picture

November 29, 2018

US Health: The CDC released new data this week on US life expectancy and rates of addiction and suicide. The findings are alarming. Life expectancy in the US was flat or dropped for the third straight year. This is the first time such a sustained decline has happened since 1915 to 1918 when World War I and the Spanish Flu pandemic resulted in a four-year decline. Driving forces of the decline include the fact that drug overdoses hit a new annual high (over 70,000) as did suicide-related deaths.

More US Kids Uninsured: Another grim figure was released today as the rate of uninsured children increased for the first time in nearly a decade. Georgetown University released new statistics showing that approximately 276,000 more children were uninsured in 2017 than in 2016. No state (except DC) experienced a decline in uninsured rates for children, with most of the increases occurring in states that did not expand Medicaid.

Part D rule: The Trump Administration released a new proposed rule that could have large implications for Part D plans, beneficiaries, and drug companies. The plan includes two large changes. The first is that a Part D plan can, under certain circumstances, refuse coverage for some drugs in the six protected classes. They would still have to cover at least two drugs in each class. The other big change is that it would “re-define negotiated price as the baseline, or lowest possible, payment to a pharmacy”. This would result in lower beneficiaries’ out of pocket costs.

Exchange Enrollment: CMS released new Open Enrollment data for the Healthcare.gov states (states HHS operates). Comparing the same point in time to last year, enrollment is down about 11%. New enrollment is down far more than returning enrollments.

Two additional data points on enrollment:

  • Ehealth, one of the major online brokers, noted a significant increase in take-up among the unsubsidized for short-term plans, relative to last year. Nearly 70% of those not receiving subsidies selected into short-term plans this year relative to 56% last year.
  • KKF released new health survey data. Only 30% of those who are either uninsured or purchased individual coverage were aware the mandate had been repealed (40% said that Congress has not gotten rid of the penalty). This is a sign that the effects of the mandate repeal may take several years to be fully realized.

1332 guidance: CMS released illustrations of the types of 1332 waivers the Administration would accept as a result of the new guidance. The waivers include increased flexibilities around subsidy structure, changes to types of plans eligible for premiums or could be on an Exchange, and types of risk stabilization programs. You can read more here.