CBO: Medicare for All Gives ‘Many More’ Coverage but ‘Potentially Disruptive’

May 22, 2019

Experts from Congress’s nonpartisan budget office testified Wednesday that a single-payer health care system would result in “many more” people with health insurance but would also be “potentially disruptive” and increase government control.

The Congressional Budget Office (CBO) experts made the remarks at the second hearing on a single-payer, “Medicare for All” system that House Democrats have held this year, this time at the House Budget Committee.

Experts from Congress’s nonpartisan budget office testified Wednesday that a single-payer health care system would result in “many more” people with health insurance but would also be “potentially disruptive” and increase government control.

The Congressional Budget Office (CBO) experts made the remarks at the second hearing on a single-payer, “Medicare for All” system that House Democrats have held this year, this time at the House Budget Committee.

“Many more people would probably have health insurance as a result but the government would take much more control over the health care system,” said CBO deputy director Mark Hadley.

He noted that because health care represents around one-sixth of the economy, “those changes could significantly affect the overall U.S. economy” and be “potentially disruptive….”

Read the full The Hill article

Datapoint: AbbVie Cuts Humira Price to Boost Skyrizi Sales

May 22, 2019

Industry analysts say AbbVie’s recent price cuts to its best-selling anti-inflammatory drug Humira might be a move to secure favorable formulary placement for Skyrizi, the drugmaker’s lower-cost alternative to Humira that won FDA approval last month. Efforts to secure preferred placement for Skyrizi “may trigger a price war,” Bernstein analyst Ronny Gal recently wrote in a note to clients. For the treatment of plaque psoriasis, Humira currently holds preferred status for 8% of covered lives, growing to 60% including prior authorization and/or step therapy. The drug is classified as a specialty product for 28% of lives.

Industry analysts say AbbVie’s recent price cuts to its best-selling anti-inflammatory drug Humira might be a move to secure favorable formulary placement for Skyrizi, the drugmaker’s lower-cost alternative to Humira that won FDA approval last month. Efforts to secure preferred placement for Skyrizi “may trigger a price war,” Bernstein analyst Ronny Gal recently wrote in a note to clients. For the treatment of plaque psoriasis, Humira currently holds preferred status for 8% of covered lives, growing to 60% including prior authorization and/or step therapy. The drug is classified as a specialty product for 28% of lives.

SOURCE: MMIT Analytics, as of 5/21/19

How May Health Insurer Fee’s 2020 Return Impact Insurers?

May 22, 2019

As insurers spend the next several weeks finishing 2020 bids for Medicare Advantage (MA) and Part D as well as Affordable Care Act exchanges, their concerns center on the expected return of the ACA’s health insurer fee (HIF) in 2020.

Industry experts tell AIS Health that the HIF’s return alone wouldn’t be significant for most managed care companies, since plans pass the fee through to consumers via higher premium rates — though they concede this pass-through may not be possible in the competitive MA market.

By Judy Packer-Tursman

As insurers spend the next several weeks finishing 2020 bids for Medicare Advantage (MA) and Part D as well as Affordable Care Act exchanges, their concerns center on the expected return of the ACA’s health insurer fee (HIF) in 2020.

Industry experts tell AIS Health that the HIF’s return alone wouldn’t be significant for most managed care companies, since plans pass the fee through to consumers via higher premium rates — though they concede this pass-through may not be possible in the competitive MA market.

“I would say that the concerns are more about, will it [i.e., the HIF] actually return or not. It’s noticeable, it’s [going to account for] 1% to 2% [of premium increase], maybe 3% of premiums in the worst case…but it’s not going to be the biggest driver of your premium growth,” says Jason Karcher, an actuary in the Milwaukee office of Milliman, Inc.

To Ross Weiler, a principal with Day Health Strategies LLC, the HIF is more of a market issue. “It’s just one more pricing challenge for the market which will result in some people being unable to afford coverage,” he says.

The bottom line? “You’re going to have winners and losers,” Weiler says. “An employer who can successfully move to self-funding fares better [since the HIF won’t apply], but that leaves the insured risk pool a little worse….So you’ve got market dynamic changes that by themselves are not dramatic, but you add them up” — and it could cause cost-prohibitive premiums.

Milliman expects the HIF to reach roughly $15.5 billion in 2020, Karcher says.

Federal Judge Signals Reluctance to Block Short-Term Plans

May 21, 2019

A federal judge on Tuesday indicated he wasn’t willing to block the Trump administration’s rule expanding access to short-term, limited-duration health plans since Congress didn’t limit them in the Affordable Care Act or in the six years after its passage.

U.S. District Judge Richard Leon heard a second round of arguments in the lawsuit over the Trump administration’s reversal of the Obama administration’s cap on short-term plans.

A federal judge on Tuesday indicated he wasn’t willing to block the Trump administration’s rule expanding access to short-term, limited-duration health plans since Congress didn’t limit them in the Affordable Care Act or in the six years after its passage.

U.S. District Judge Richard Leon heard a second round of arguments in the lawsuit over the Trump administration’s reversal of the Obama administration’s cap on short-term plans.

The not-for-profit Association for Community Affiliated Plans first sued to block the rule last year. It was finalized in August and went into effect in early October. In the first set of oral arguments, Leon told the plaintiffs they sought relief prematurely, before they could show proof that the Trump administration’s regulation would deal them a financial blow….

Read the full Modern Healthcare article

Datapoint: Trump Administration Urges Courts to Restore Medicaid Work Requirements

May 21, 2019

Officials at the Department of Justice and HHS last week asked a federal appeals court to restore Medicaid work requirement programs in Arkansas and Kentucky. The court earlier this year ruled that work incentives do not match the basic values of the Medicaid program. Medicaid enrollment has dropped 6.8%, to 832,326 lives in Arkansas, and 7.9%, to 1.39 million lives in Kentucky since May 2018.

Officials at the Department of Justice and HHS last week asked a federal appeals court to restore Medicaid work requirement programs in Arkansas and Kentucky. The court earlier this year ruled that work incentives do not match the basic values of the Medicaid program. Medicaid enrollment has dropped 6.8%, to 832,326 lives in Arkansas, and 7.9%, to 1.39 million lives in Kentucky since May 2018.

Source: AIS’s Directory of Health Plans