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...

AP: Biden Takes Aim At 'Junk' Insurance, Vowing To Save Money For Consumers Being Played As 'Suckers' Biden invited Cory Dowd to tell his story at the White House event to spotlight the initiative. Dowd in 2019 purchased a high-deductible health care plan when he returned stateside after serving in the Peace Corps in Ghana but before he started graduate school and was able to get on a student health plan. He thought the plan would protect him in the case of a medical emergency. But just weeks before he started school, he had to have emergency surgery to remove his appendix. Months later, the hospital called him to tell him his insurer would only cover a small portion of his bill and that he would have to pay more than $37,000 out of pocket. (Boak, 7/7)

Healthcare Dive: CMS floats 1.25% physician fee cut, 2.8% outpatient bump in new proposed rules The CMS on Thursday proposed major updates to physician and outpatient and ambulatory surgical center payments under Medicare for 2024. Regulators proposed cutting payments to physicians by 1.25% compared to this year, in part due to a 3.34% decrease in the conversation factor, in its 2024 Medicare Physician Fee Schedule rule. The CMS uses the conversation factor to calculate payments based on the cost and difficulty of a medical procedure or service. In a separate rule, the agency proposed a 2.8% pay increase for hospital outpatient facilities. The increase, in the agency’s Outpatient Prospective Payment System and Ambulatory Surgical Center 2024 proposed rule, reflects a 3% boost in the hospital market basket rate and a 0.2% decrease in the productivity adjustment. (Halleman, 7/14)

Stat: Biden Targets Hefty Hospital 'Facility Fees' That Often Surprise Patients As part of the Biden administration’s broader efforts to lower health care costs, the White House announced new guidelines on Friday targeting a few of the most common sources of sticker shock. The new policy initiatives target some of the usual suspects: surprise billing, which was restricted in 2020 yet persists as health care providers exploit loopholes; short-term insurance policies that often fail to cover essential treatment; and high-interest credit cards and payment plans especially marketed to help patients cover medical debt. (Merelli, 7/7)

For a Deeper Dive...

KFF Health News: As Nonprofit Hospitals Reap Big Tax Breaks, States Scrutinize Their Required Charity Spending The public school system here had to scramble in 2018 when the local hospital, newly purchased, was converted to a tax-exempt nonprofit entity. The takeover by Tower Health meant the 219-bed Pottstown Hospital no longer had to pay federal and state taxes. It also no longer had to pay local property taxes, taking away more than $900,000 a year from the already underfunded Pottstown School District, school officials said. (Miller and Hawryluk, 7/11)

The Washington Post: U.N.: Black Maternal Health In Crisis Across Hemisphere, Not Just In U.S. Black women in the Americas bear a heavier burden of maternal mortality than their peers, but according to a report released Wednesday by the United Nations, the gap between who lives and who dies is especially wide in the world’s richest nation — the United States. Of the region’s 35 countries, only four publish comparable maternal mortality data by race, according to the report, which analyzed the maternal health of women and girls of African descent in the Americas: Brazil, Colombia, Suriname and the United States. And while the United States had the lowest overall maternal mortality rate among those four nations, the report said Black women and girls were three times more likely than their U.S. peers to die while giving birth or in the six weeks afterward. (Johnson, 7/12)

Politico: Hospitals Could Face New Price Transparency Requirements CMS proposed major changes to how hospitals post prices for certain services in a bid to make them easier for consumers to understand. The agency included new requirements for hospital charge data in the proposed Hospital Outpatient Prospective Payment System rule released Thursday. The rule, which lays out payment rates and policy changes for 2024, creates a template for hospitals to share data intended to help consumers price shop. (King, 7/13)

Stat: How A Key Senate Committee Is Planning To Regulate PBMs A key Senate health care panel has developed a plan to tackle reforms to middlemen in the pharmacy drug payment system, according to bill text obtained by STAT. The draft legislation, authored by Senate Finance Chair Ron Wyden (D-Ore.) and ranking member Mike Crapo (R-Idaho), includes several measures to regulate how pharmacy benefit managers are paid by health plans to negotiate with drugmakers. (Cohrs, 7/13)

Politico: Chamber Of Commerce Requests Preliminary Injunction In Drug Price Negotiation Lawsuit The U.S. Chamber of Commerce and its subsidiaries asked a federal court on Wednesday to grant a preliminary injunction to halt implementation of the Inflation Reduction Act’s drug pricing provisions. The new motion “focuses solely on the due process clause” and asks the court to “preserve the status quo” while further litigation plays out. CMS plans to publish a list of the first up to 10 drugs selected for negotiations by Sept. 1 — an action the Chamber of Commerce argues has already harmed the manufacturers of drugs expected to be selected. (Lim, 7/12)

Stat: FDA Approves First Over-The-Counter Birth Control Pill In a highly anticipated move, the Food and Drug Administration on Thursday approved the first over-the-counter birth control pill, a decision that could transform the way contraception is delivered in the United States. For the first time, people will now be able to readily purchase birth control online and at pharmacies, convenience stores, and grocery stores without a prescription, a requirement that has been seen as a hurdle to greater access to contraception. Called the Opill, it is expected to become available in the first quarter of 2024, but the pricing has not yet been disclosed by Perrigo, the company that manufactures the pill. (Silverman, 7/13)

Stat: HHS Leader Tells Covid Vaccine Makers To Set 'Reasonable' Prices Amid ongoing controversy over the cost of medicines, a key Biden administration official told Covid-19 vaccine manufacturers that their next round of shots should be priced reasonably, a move that comes after two key suppliers were accused of price gouging. (Silverman, 7/13)

Reuters: VP Kamala Harris Unveils Proposed Rule Change To Cut US Childcare Costs U.S. Vice President Kamala Harris on Tuesday announced new steps to lower the cost of childcare for American families with a proposal that would cap co-payments under a block grant program that serves 1.5 million children and their families each month. "This is a critical issue for almost every family in our country," Harris told reporters. "Low-income families often spend one-third, one-third of their yearly income on childcare, more than they spend on their rent or mortgage." (7/11)

KFF Health News: What You Need To Know About The Drug Price Fight In Those TV Ads In recent months ominous ads about prescription drugs have flooded the TV airwaves. Perhaps by design, it’s not always clear who’s sponsoring the ads or why. Or, for that matter, why now? The short answer is that Congress is paying attention. House and Senate members from both parties have launched at least nine bills, parts of which may be packaged together this fall, that take aim at pharmacy benefit managers, companies that channel prescription drugs to patients. Here’s a primer to help you decipher what’s happening. (Allen, 7/10)

Stat: Biden’s NIH Nominee Is Languishing In Congress Sen. Bernie Sanders’ rare move to delay President Biden’s health care nominees has put the drug pricing firebrand and the White House in a standoff — and public health advocates worry the feud could squeeze out an otherwise uncontroversial pick to lead the country’s top science agency. (Owermohle, 7/10)

The Wall Street Journal: Millions Of People Booted From Medicaid After Pandemic Millions of people are losing Medicaid coverage in the wake of the Covid-19 pandemic. Enrollment in the health program for the low-income and disabled grew to 95 million during the pandemic, as states stopped checking to make sure people were eligible. Now states have started checking again, and more than 1.6 million people have been kicked off the program in the past three months, according to KFF, a health-analysis foundation. Federal regulators estimate that 15 million to 17 million people will eventually be pushed off Medicaid. (Armour, 7/8)

Stat: House Panel To Mark Up Pandemic-Preparedness Bill Next Week
A House subcommittee will next week mark up a package of public health bills, including pandemic-preparedness legislation, according to five lobbyists. The House Energy & Commerce Committee hasn’t yet announced the markup, and the lobbyists didn’t know the exact date. But time is running out for reauthorizing a law that created several of the federal government’s biodefense and pandemic-preparedness programs. (Wilkerson, 7/7)

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