Starting Wednesday, you’ll notice a new weekly feature in Morning Briefing. Our Prescription Drug Watch will include news, research and opinion pieces on the pharmaceutical industry. KHN’s coverage of prescription drug development and costs is supported in part by the Laura and John Arnold Foundation. There’s no need to adjust your settings to receive this roundup; you can share your feedback here.
In This Edition:
From Kaiser Health News:
Florida and Oklahoma counties are among the hardest hit by UnitedHealthcare's pullout from health law exchanges. (Phil Galewitz, 4/26)
When consumers who have been injured sue and win an award, insurance plans routinely demand that they be reimbursed for medical costs that they covered. The Supreme Court this term threw a small chink into that strategy. (Michelle Andrews, 4/26)
Private insurers that administer Medicaid for the poor also face limits on profits and requirements to provide sufficient doctors. (Jay Hancock, 4/26)
California is inching closer to a first-in-the-nation request for a federal ruling that would allow the state’s Obamacare exchange to sell health plans to immigrants who are living in the country illegally. (Ana B. Ibarra, 4/26)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Insult To Injury'" by Dave Coverly, Speed Bump.
Here's today's health policy haiku:
WHAT ABOUT THESE NEW MEDICAID REGS?
Will the tighter rules
Really change the ways in which
Plans do business?
If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
Summaries Of The News:
The long-awaited regulation, the biggest for Medicaid managed care in a decade, changes many aspects of how large insurance contractors who administer care for some of the most vulnerable patients.
Modern Healthcare: 85% Medical-Loss Ratio In Final Managed Medicaid Rule
The CMS has finalized a long-awaited rule that will overhaul managed Medicaid, which has not been updated in a decade. The sweeping 1,425-page rule, which was proposed last May, caps insurer profits, requires states to more rigorously supervise the adequacy of plans' provider networks, encourages states to establish quality rating systems for plans, allows more behavioral healthcare in institutional settings and promotes the growth of managed long-term care. But the CMS deferred to state control for several issues. (Dickson and Herman, 4/25)
Kaiser Health News: Administration Says New Rules For Medicaid Plans Will Improve Service For Enrollees
The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors. For consumers the most visible change may eventually be quality ratings intended to reflect Medicaid plans’ health results and customer experiences. The administration agreed to move slowly on such a sensitive industry issue, saying it would develop the scores over several years. (Hancock, 4/26)
The Associated Press: Feds Issue New Standards For Medicaid Insurance Plans
The Obama administration Monday set new standards for Medicaid private insurance plans, which in recent years have become the main source of coverage for low-income people. The rules apply to insurers operating as Medicaid middlemen in 39 states and Washington, DC. Each state runs its own program, although the federal government pays most of the cost. Private insurers now provide coverage to about two-thirds of the more than 70 million Medicaid recipients, and the rules had not been updated for more than 10 years. (Alonso-Zaldivar, 4/25)
The Hill: Obama Administration Issues Sweeping New Medicaid Regulation
The regulation updates rules concerning what is known as Medicaid managed care, where states contract with private health insurers to provide benefits to low-income people through Medicaid, a system that has grown in recent years to 39 states and two thirds of enrollees. The final rule, issued Monday, imposes requirements on how much of insurers revenue must go towards paying medical costs, as opposed to administrative costs or profits. (Sullivan, 4/25)
Morning Consult: Long-Awaited Managed Care Rules For Medicaid, CHIP Are Final
Medicaid managed care services are offered by risk-based managed care organizations, which contract with state Medicaid programs to offer care to enrollees. Essentially, they are the private insurer alternative to traditional fee-for-service Medicaid. CMS hasn’t issued any new regulations to the program since 2002, but a lot has changed since then. Not only has the Medicaid program itself grown under the Affordable Care Act, but now about 80 percent of Medicaid enrollees are served through managed care delivery systems, according to CMS. (Owens, 4/25)
CQ Healthbeat: Medicaid Rule Requires Health Plans To Meet Financial Standards
Health insurers that participate in Medicaid will have to spend a minimum amount of the money they receive on medical care, under a new Centers for Medicare and Medicaid Services rule released late Monday. (Evans, 4/25)
The panel members said the trial was not well-controlled, noting that it only involved 12 patients without an adequate placebo control.
The New York Times: Advisers To F.D.A. Vote Against Duchenne Muscular Dystrophy Drug
In a confrontation between the hopes of desperate patients and clinical trial data, advisers to the Food and Drug Administration voted on Monday not to recommend approval of what would become the first drug for Duchenne muscular dystrophy. The negative votes came despite impassioned pleas from patients, parents and doctors who insisted that the drug, called eteplirsen, was prolonging the ability of boys with the disease to walk well beyond when they would normally be in wheelchairs. (Pollack, 4/25)
The Wall Street Journal: FDA Panel Votes Not To Recommend Approval For Muscular Dystrophy Drug
“I felt this wasn’t a well-controlled study,” said panel chairman G. Caleb Alexander, an associate epidemiology professor at the Johns Hopkins School of Public Health. The panel members who abstained said they were undecided because they were moved by public testimony from parents who believed their children had been helped by the drug. The decision followed decidedly negative comments from FDA reviewers who concluded that the study fell far short of producing enough evidence. (Burton, 4/25)
The Associated Press: Muscular Dystrophy Drug Falls Short At High-Stakes Meeting
Federal health advisers voted against an experimental treatment for muscular dystrophy on Monday, the latest in a series of setbacks for the Sarepta Therapeutics' drug, which has become a rallying point for patients and families affected by the deadly disease. (Perrone, 4/25)
CQ Healthbeat: Lawmakers Lobby For Rare Drug Approval, But Evidence Is Lacking
A Food and Drug Administration advisory committee on Monday heard arguments for the approval of a drug to treat Duchenne Muscular Dystrophy, a disease that affects young boys and currently has no approved treatment. The disease, which results in the loss of muscle use, affects one in 3500 boys. It is 100 percent fatal and most affected have a lifespan of fewer than 25 years. (Siddons, 4/25)
Some of the companies priced their plans too low in the early years of the health marketplaces. In other news, a preview of the possible fallout for insurers if a court rules against the Obama administration on cost sharing subsidies, several outlets look at UnitedHealth's pullback and California lawmakers weigh a measure to allow immigrants in the country illegally to buy coverage on the state marketplace.
The Hill: ObamaCare Premiums Expected To Rise Sharply Amid Insurer Losses
Health insurance companies are laying the groundwork for substantial increases in ObamaCare premiums, opening up a line of attack for Republicans in a presidential election year. Many insurers have been losing money on the ObamaCare marketplaces, in part because they set their premiums too low when the plans started in 2014. The companies are now expected to seek substantial price increases. (Sullivan, 4/25)