Gregg's Top Three Health Policy Articles

If you can only read three things about health policy this week, I suggest...

The Top Three...

Politico: Congress Nears Deal On Disaster Aid, Funding Patch To Avert Pre-Christmas Shutdown Congressional leaders are closing in on a deal to fund the government into early next year, along with tens of billions of dollars in disaster aid, as they work to avoid a holiday shutdown. The burgeoning agreement comes after weeks of House and Senate leadership negotiations, which included top appropriators, ahead of the Dec. 20 deadline. Text of the funding bill is expected over the weekend or early next week to allow both chambers to pass the measure before lawmakers leave town until January. (Carney and Scholtes, 12/12)

Bloomberg: Lawmakers Plan Bill Forcing CVS, Cigna, UnitedHealth To Sell Pharmacies A bipartisan coalition of US lawmakers has drafted legislation that would force prescription drug middlemen to divest pharmacies they own. Some of the largest US health-care companies own pharmacy benefit management units that negotiate drug prices for employers and other customers. If enacted, the policy would compel CVS Health Corp., Cigna Group and UnitedHealth Group Inc. to shed drug-dispensing operations that have become profit centers for the vertically integrated conglomerates. (Tozzi, 12/11)

Stateline: Millions Will See Rise In Health Insurance Premiums If Federal Subsidies Expire Andrea Deutsch, the mayor of Narberth, Pennsylvania, and the owner of a pet store in town, doesn’t get health care coverage through either of her jobs. Instead, she is enrolled in a plan she purchased on Pennie, Pennsylvania’s health insurance exchange. ... The 57-year-old, who is diabetic, pays $638.38 per month for health care coverage — about half of the $1,272.38 she’d owe without the enhanced federal subsidies Congress and the Biden administration put in place in 2021. (Chatlani, 12/11)

For a Deeper Dive...

The Hill: Gallup Poll: Majority Of Americans Say Health Care Is Government Responsibility Sixty-two percent of Americans say it’s the federal government’s responsibility to ensure everyone has health care coverage, a survey from Gallup found. The figure is the highest it’s been in more than a decade. It slipped to its low of 42 percent in 2013, during the difficult rollout of the Affordable Care Act (ACA), commonly known as ObamaCare. (Irwin, 12/9)

The Washington Post: Energized By Next Trump Term, Red States Move Agendas Further Right Red-state leaders emboldened by Donald Trump’s presidential victory are not waiting for him to take office to advance far more conservative agendas at home. Idaho lawmakers want to allow school staff to carry concealed firearms without prior approval and parents to sue districts in library and curriculum disputes. Lawmakers in Oklahoma plan to further restrict abortion by limiting the emergency exceptions and to require the Ten Commandments to be displayed in public schools, while their counterparts in Arkansas are moving to create the felony offense of “vaccine harm,” which could make pharmaceutical companies or their executive officers potentially criminally liable. (Hennessy-Fiske, 12/13)

The Washington Post: 3 In 5 Underinsured Adults Said They Avoided Needed Care Because Of Cost Some 8 percent of Americans, or an estimated 26 million people, lacked health insurance in 2023, according to the Commonwealth Fund 2024 Biennial Health Insurance Survey. Before implementation of the Affordable Care Act in 2010, nearly twice as many people, 16 percent of the population, were without health coverage, the Commonwealth Fund reported, citing data from the Centers for Disease Control and Prevention. (McMahan, 12/9)

MedPage Today: Should Hospitals Be Paid The Same As Doctors' Offices For The Same Service? The idea of requiring site-neutral payments in Medicare -- in which providers would be reimbursed at the same rate for performing the same service, regardless of where it's performed -- appears to be gaining steam on Capitol Hill. "We are decreasing the out-of-pocket expense for someone receiving the exact same care at the same doctor's office with the same equipment and the same nurse" in cases where the cost of the service increased after the hospital bought the doctor's practice, Sen. Bill Cassidy, MD (R-La.), said Wednesday at a site-neutral payment event sponsored by Politico and the Leukemia & Lymphoma Society. Cassidy, ranking member of the Senate Health, Education, Labor, & Pensions (HELP) Committee, was referring to a bill which he and Sen. Maggie Hassan (D-N.H.) are developing. (Frieden, 12/12)

Modern Healthcare: Why Private Equity Investment In Healthcare May Rise In 2025 Private equity investment in healthcare is expected to pick up in 2025 but still fall short of the highs of 2021, merger and acquisition advisers said. Private equity-linked healthcare transaction volume is poised to rebound after a sluggish 2024 as interest rates cool, state-led oversight bills lose momentum and a new presidential administration begins. Corporate investors will likely prioritize deals that involve healthcare information technology and other administrative support services over physician practices, industry observers said. (Kacik, 12/12)

Modern Healthcare: 'Ghost Networks' Lawsuit May Signal Trouble For Insurers
Health insurers have long faced criticism over inaccurate provider directories, and a recent lawsuit suggests more scrutiny could be on the horizon. Anthem Blue Cross Blue Shield of New York, an Elevance Health subsidiary, is battling a trio of policyholders seeking class action status who allege the insurer deliberately includes out-of-network providers in its lists. These alleged "ghost networks" can deter patients from seeking care or increase their costs and can cause headaches for providers. (Berryman and Early, 12/11)

For the Visual Among Us...

A few years ago I started a weekly e-mail for friends and colleagues who want to keep up on major federal health policy developments but did not have time to plod through all the minutiae--they were busy doing important things like running organizations and taking care of patients! Much to my surprise, it became pretty popular. I have now converted to a weekly newsletter format so you can manage your own subscription preferences and forward to others that might be interested.

These summaries represent my judgement on health policy issues that may not on the front pages, but are relevant to clinicians, administrators, and educators. I monitor many news sources and clipping services to identify content for this newsletter and I try hard to be as factual, balanced, and non-partisan as possible. While the articles are written by others (with credit attributed), the choice of what to include is entirely mine. If you are interested in receiving a daily summary of health policy news, you might consider signing up for the KHN Morning Briefing. If you enjoy podcasts, I suggest What the Health? and Tradeoffs.

-Gregg S. Margolis, PhD