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...

Fierce Healthcare: Sign-Ups On ACA Exchanges Up 18% Year Over Year To 5.5M So Far Sign-ups for plans on the Affordable Care Act's exchanges reached 5.5 million during the first five weeks of open enrollment, according to the latest figures from the Centers for Medicare & Medicaid Services (CMS). The CMS said Wednesday that figure includes 1.2 million people who have newly signed up for coverage through the exchanges as well as 4.3 million people who have returned to the exchanges to renew or select a new plan for 2023. That represents an 18% increase year over year; in 2021, 4.6 million people had signed up for plans through the first five weeks of the enrollment period. (Minemyer, 12/7)

The Hill: Repeal Of Military Vaccine Mandate Shows Changing Pandemic Politics By giving in to Republican demands, Democrats acknowledged that the public has moved on, and there’s not much appetite for any sort of virus-fighting rules. “The policy that the Department of Defense implemented in August of 2021 … was absolutely the right policy. It saved lives and it made sure our force was as ready as it possibly could be in the face of the pandemic,” House Armed Services Committee Chairman Adam Smith, (D-Wash.), said during a speech before the House Rules Committee defending the authorization bill. “As we are here in December 2022, does that August 2021 policy still make sense? We don’t believe that it is, and I don’t believe that it is,” Smith said. (Weixel, 12/9)

Axios: What Happens When The COVID National Emergency Ends While much has been made about the COVID-19 public health emergency, there's another less-discussed emergency declaration that Republicans could target in the next Congress, bringing changes for employer-sponsored health plans, COBRA and flexible spending accounts. (Knight, 12/9)

For a Deeper Dive...

Healthcare Dive: Payers, providers applaud new CMS prior authorization rule. Payers and providers came out in support of a new rule from the CMS proposing requirements on certain health insurers in a bid to improve the prior authorization process, though provider groups say there’s more to be done to codify measures into law for Medicare Advantage plans. Previous regulation from the Trump administration targeting prior authorization, a process in which a physician must get the green light from an insurer for medication or treatment before administering it, was heavily criticized by both health insurers and hospitals. (Pifer, 12/8)

Health Affairs: Paying For ACA Cost-Sharing Reductions: Are Premiums Too Low Or Too High? Access to health insurance with affordable premiums is only one aspect of access to health care. Consumers may face barriers to care if a plan’s cost-sharing requirements (e.g., deductibles and coinsurance) are unaffordable. (Bohl, Karcher, Novak and Uccello, 12/6)

Healthcare Dive: 18M Project to Lose Medicaid Coverage at End of COVIC-19 Emergency  Many people who are currently enrolled in Medicaid will transition to other coverage, but 3.8 million people will completely lose insurance, according to the Robert Wood Johnson Foundation. Many people who are currently enrolled in Medicaid will transition to other coverage options, but 3.8 million people will completely lose coverage, the report projected. Nineteen states are expected to see their uninsured rates spike by more than 20%. The researchers also projected that 3.2 million children will transition from Medicaid to separate Children’s Health Insurance Program health plans. (Kelly, 12/6)

Axios: Some Red State Hospitals Pitch Medicaid Expansion To Solve Rural Health Woes Hospitals in some non-Medicaid expansion states are pitching expansion as a way to help solve the rural health crisis. But the industry is hardly speaking with one voice. Facilities with fewer commercially insured patients that treat a large number of uninsured people see expansion as a potential lifeline in tough economic times. (Dreher, 12/8)

KHN: Paxlovid Has Been Free So Far. Next Year, Sticker Shock Awaits. Nearly 6 million Americans have taken Paxlovid for free, courtesy of the federal government. The Pfizer pill has helped prevent many people infected with covid-19 from being hospitalized or dying, and it may even reduce the risk of developing long covid. But the government plans to stop footing the bill within months, and millions of people who are at the highest risk of severe illness and are least able to afford the drug — the uninsured and seniors — may have to pay the full price. And that means fewer people will get the potentially lifesaving treatments, experts said. (Recht, 12/7)

KFF: How Much Could COVID-19 Vaccines Cost the U.S. After Commercialization? The federal government has spent more than $30 billion on COVID-19 vaccines, including the new bivalent boosters, incentivizing their development, guaranteeing a market, and ensuring that these vaccines would be provided free of charge to the U.S. population. However, the Biden Administration has announced that it no longer has funding, absent further Congressional action, to make further purchases and has begun to prepare for the transition of COVID-19 vaccines to the commercial market. This means that manufacturers will be negotiating prices directly with insurers and purchasers, not just the federal government, and prices are expected to rise. Elsewhere, we have analyzed the implications of commercialization for access to and coverage of COVID-19 vaccines, finding that most, but not all, people will still have free access. Still, the cost of purchasing vaccines for the population is likely to rise on a per dose basis, though the extent to which it affects total health spending is dependent on vaccine uptake and any negotiated discounts, among other factors. (J Kates, L Cox, J Michaud, 12/7)

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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