Gregg's Top Three Health Policy Articles

Health policy impacts everyone, but it can be hard to know what is important. If you can only read three things about health policy this week, I suggest...

The Top Three...

The Wall Street Journal: Health Insurers Square Off With Biden Administration Over Medicare Payments Health insurers are tussling with the Biden administration over a proposal that could curtail federal payments for some private Medicare plans, a high-stakes issue for the industry because the business represents a growth engine. In a continuing effort that included a Super Bowl ad, insurers and their allies argue that the administration plans a payment cut next year for the popular health plans, which are known as Medicare Advantage. The tagline for the commercial, from the industry-backed Better Medicare Alliance, was “Tell the White House: Don’t cut Medicare Advantage.” The group has also rallied Medicare Advantage enrollees to call members of Congress, and it has set up a site at dontcutmedicareadvantage.com. (Mathews, 3/2)

NBC News: Drugmaker Eli Lilly Caps The Cost Of Insulin At $35 A Month, Bringing Relief For Millions The move, experts say, could prompt other insulin makers in the U.S. to follow suit. The change, which Eli Lilly said takes effect immediately, puts the drugmaker in line with a provision in the Inflation Reduction Act, which last month imposed a $35 monthly cap on the out-of-pocket cost of insulin for seniors enrolled in Medicare. Insulin makers continue to face pressure from members of Congress and advocacy groups to lower the cost of the lifesaving medication. Insulin costs in the U.S. are notoriously high compared to the costs in other countries; the RAND Corporation, a public policy think tank, estimated that in 2018, the average list price for one vial of insulin in the U.S. was $98.70. (Lovelace Jr., 3/1)

AP: N. Carolina Legislators Reach Medicaid Expansion Deal North Carolina legislative leaders announced Thursday an agreement to expand Medicaid to hundreds of thousands of additional low-income adults through the Affordable Care Act. The deal, which likely won’t be voted on until later this month at the earliest, marks a milestone for Republican lawmakers, most of whom opposed expansion for a decade until recently, and for hospitals and patient advocates who sought it all that time. (Robertson, 3/2)

For a Deeper Dive...

The New York Times: Rural Hospitals Are Shuttering Their Maternity Units Three days before Christmas, the only hospital in this remote city on the Yakama Indian Reservation abruptly closed its maternity unit without consulting the community, the doctors who delivered babies there or even its own board. At least 35 women were planning to give birth at Astria Toppenish Hospital in January alone, and the sudden closure — which violated the hospital’s commitment to the state to maintain critical services in this rural area — threw their plans into disarray. (Rabin, 2/26)

Healthcare Finance News: Medicare Advantage Sees Fewer Avoidable Hospitalizations Than Original Medicare Medicare Advantage had fewer avoidable hospitalizations for ambulatory care−sensitive conditions (ACSCs) when compared to traditional Medicare, but were more likely to have observation stays and emergency department direct discharges for the same conditions, according to findings published in the Journal of the American Medical Association. These findings raise the possibility of a "shifting effect," authors said, whereby Medicare Advantage patients are more likely than traditional Medicare patients to be treated under observation status or in the ED instead of being admitted to the hospital. (Lagasse, 2/28)

The Wall Street Journal: How Doctors Use AI To Help Diagnose Patients Artificial intelligence is slowly changing the care that you get at the doctor’s office and in hospitals. At Mayo Clinic’s cardiology department, doctors use an artificial-intelligence program to help detect new heart problems. Elsewhere, a group of primary-care doctors is using it to help identify an eye condition that can lead to blindness. A number of hospitals are using it to catch patients at risk for sepsis. (Reddy, 2/28)

Healthcare Dive: Why regulators didn’t challenge Amazon-One Medical deal, despite data concerns.  The ecommerce giant’s $3.9 billion buy of primary care company One Medical closed last week without a challenge from the FTC, even as consumer protection groups aired worries about the tie-up. (Pifer, 3/1)

Reuters: Biden Says Other Companies Will Slash Insulin Prices After Eli Lilly Move U.S. President Joe Biden said on Wednesday that other pharmaceutical companies will have to lower their insulin prices in the wake of Eli Lilly's decision to slash its prices for the popular diabetes treatment. Eli Lilly said on Wednesday it will cut list prices by 70% for its most commonly prescribed insulin products, Humalog and Humulin, beginning from the fourth quarter of this year. "Guess what that means?," Biden told Democrats gathered in Baltimore for an annual retreat. "Every other company making it, someone's gonna have to lower their price." (Hunnicutt, 3/1)

USA Today: Community Health Centers Can Fill America's Primary Care Gap: Report Nearly a third of Americans lack access to primary care, according to a new report. More than 100 million people in the United States don't have a primary care provider, and about a quarter of those are children, according to the report, "Closing the Primary Care Gap," released Monday by the National Association of Community Health Centers. (Hassanein, 2/28)

Stat: The Other Way The Government Is Privatizing Medicare A new approach to paying doctors and hospitals — originally billed as a way to bolster traditional Medicare — might be speeding the public health insurance program’s privatization. Medicare Advantage typically gets credited, or blamed, for moving beneficiaries into a system run by private health insurers. The program has grown rapidly since its inception; nearly half of people on Medicare are now in a private plan. But there may be another wave of privatization coming. (Wilkerson, 3/3)

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?

-Gregg S. Margolis, PhD