In This Edition:
From Kaiser Health News:
News reports have led many consumers to blame drugmakers for the rapidly rising costs of some commonly used generic drugs. But changes made by insurers often play a major role, too. (Michelle Andrews, 7/26)
The Centers for Disease Control and Prevention also directs that all pregnant women in the U.S. and its territories should be “assessed for possible Zika virus exposure” whenever they get a prenatal care visit. (Shefali Luthra, 7/25)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Not Exactly'" by Bob and Tom Thaves.
Here's today's health policy haiku:
OBAMA SIGNS OPIOID PACKAGE
New drug law got signed
But no one noticed CARA.
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:
In his endorsement at the Democratic National Convention, Bernie Sanders touted his efforts to pull Hillary Clinton toward his stances on health care, including proposals to let people join Medicare early and increase funding for community health centers.
Stat: Sanders Convention Speech Cites Clinton Health Care Concessions
Bernie Sanders celebrated the health care concessions he won from Hillary Clinton Monday night as he gave a rousing endorsement to his former presidential rival. In a Democratic convention speech that revisited the agenda of his surprisingly competitive campaign for the nomination, Sanders reminded the audience that while he may have lost the race, he did succeed in convincing Clinton to support three important proposals: a “public option” for Obamacare, letting people join Medicare early, and a big funding increase for community health centers. (Kaplan, 7/26)
In other news from the 2016 presidential election —
Philadelphia Inquirer: Trump Vs. Clinton: How They Line Up On Health
[T]he Trump vs. Clinton race offers voters a stark choice, starting with their views on the Affordable Care Act, also known as Obamacare. Clinton wants to improve it and make it more affordable. Trump has vowed to kill it, starting on the day he takes office. Abortion? Clinton is decisively pro-choice; Trump, pro-life, a stance bolstered by his selection of Indiana Gov. Mike Pence, a champion of abortion restrictions, as his running mate. ... We have pulled together an at-a-glance list summarizing their views on a range of health and science issues. It shows not only their differing opinions, but also their differing styles. Clinton is given to detailed policy positions; Trump, not so much. (Giordano, 7/24)
Modern Healthcare: Success Of Pence's Medicaid Expansion Far From Settled
The success of the conservative approach to Medicaid devised by Indiana Gov. Mike Pence—Donald Trump's pick for vice president—is a mixed bag so far, according to a report that offers fodder for both sides of the political spectrum. A new analysis funded by the state shows both positive and concerning elements to Indiana's alternative Medicaid expansion. It again exposes the dichotomy of Pence embracing President Barack Obama's healthcare reform law even though his presidential running mate, Donald Trump, has called for full repeal of the Affordable Care Act. (Dickson, 7/25)
WBUR: For Some Anti-Abortion Rights Voters This Year, Neither Candidate Appeals
The 2016 Democratic Party platform includes strong pro-abortion rights language. It opposes Republican efforts to defund Planned Parenthood, as well as bids to overturn the Hyde Amendment, which limits federal funding for abortions. In contrast, the Republican platform called for repealing Roe vs. Wade and adding a "personhood" amendment to the Constitution, which protects a fetus from the beginning of its development. Here & Now's Robin Young talks to Edel Finnegan, executive director of the Pro-Life Union of Greater Philadelphia, about how abortion is being talked about by the parties and the candidates this year. (Young, 7/25)
States are weighing how to raise enough money to keep the exchanges operating. In other health law news, an analysis of insurance premium rates and a new ACO launches in Topeka, Kansas.
Roll Call: State Health Exchanges Wrestle With Budgets
State-based marketplaces survived startup problems with botched technology and political threats but continue to grapple with a fundamental challenge: financial sustainability. The 13 states that run their own exchanges face challenges in raising enough money, through user fees or state funding, to maintain their operations now that about $5 billion in early federal grants has largely run out. As states establish those budgets, they are testing decidedly disparate approaches to investments in priorities like marketing, technology and operations. (Mershon, 7/25)
Morning Consult: Are Premiums Lower Than We Think?
Insurance premiums for Affordable Care Act individual policies may not be as expensive as presumed when compared to rates before the law took effect, a recent analysis suggests. The analysis, released last week by Health Affairs, argues that though premiums are increasing, they’re actually lower than they would have been before the Affordable Care Act was implemented in 2010. That’s because the “average premiums in the individual market actually dropped significantly upon implementation of the ACA,” the analysis says. (McIntire, 7/25)
Kansas Health Institute: Insurer, Topeka Health Provider Create Accountable Care Organization
One of Kansas’ largest health insurers is trying to reduce costs and improve the quality of care for at least some of its customers in the Topeka area. Blue Cross and Blue Shield of Kansas announced Monday that it had formed an accountable care organization, or ACO, with SCL Health, the parent company of St. Francis Health, which operates a hospital and more than 20 physician clinics in the region. (Hart, 7/25)
If implemented, Medicare would set a fixed payment for all services provided during the treatment of a heart attack, instead of letting the hospital bill for each separately.
The Wall Street Journal: Medicare Proposes Fixed Payments For Treating Heart Attacks
Medicare wants to pay hospitals fixed amounts for treating heart attacks, following a move to offer set reimbursements for hip and knee replacements rather than letting providers bill for every service provided to older Americans, the Obama administration said Monday. The proposal represents the most significant extension of the Obama administration’s efforts to curb costs and improve quality of care funded by Medicare. (Radnofsky and Evans, 7/25)
The Hill: Obama Administration Pushes To Change Medicare Payments For Heart Attacks
The announcement comes as the administration, in its final months in office, seeks to further shift Medicare payments towards rewarding quality health outcomes and away from the old system of simply paying for the number of services provided. ... The idea is to incentivize saving money and providing quality care. (Sullivan, 7/25)
Modern Healthcare: CMS Proposes Mandatory Cardiac Bundled-Payment Pilot
“We think it's important to keep pushing forward on delivery system reform,” Dr. Patrick Conway, acting principal deputy administrator and chief medical officer for the CMS, told reporters in a call. “We think this is a huge opportunity.” (Whitman, 7/25)
Politico Pro: With New Cardiac Program, CMS Doubles Down On Bundled Payments
While critics say accountable care organizations and other new reform models introduced by Obamacare aren't especially effective at controlling costs, there's evidence that bundled payments tamp down spending. ... Medicare's bundled payment programs specifically make hospitals accountable for patients' care during the hospital stay and after discharge; hospitals that hit quality and cost targets are eligible for additional savings, which can be shared with participating physicians. (Diamond, 7/25)
CNBC: New Medicare Pay Models Proposed For Cardiac Care To Boost Quality, Save Money
Federal health regulators Monday proposed to test a new way to pay hospitals that treat Medicare beneficiaries for heart attacks and bypass surgery, as well as hip fractures, with an eye toward controlling costs and improving patient outcomes. Under the model proposed for a five-year demonstration project to begin next summer, which would be mandatory, hospitals would be paid on a "bundled" basis for treating such patients. (Mangan, 7/25)
Morning Consult: HHS Proposes Bundled Payments For Cardiac Care
Bundled payments aim to improve care quality and coordination by reimbursing providers for an entire episode of care, rather than reimbursing for each separate step. A bundled payment model for hip and knee replacements was launched earlier this year, and the rule proposed Monday would extend that model to include surgical treatments for hip and femur fractures beyond hip replacements. (McIntire, 7/25)
The state froze its participation in the Children's Health Insurance Program (CHIP) in the midst of the recession in 2009. Officials say as many as 40,000 children from low- and middle-income families may gain coverage. Also, Kansas Health Institute examines Medicaid payment problems for nursing homes.