FEHBlog

Reports of the demise of the American Health Care Act were premature. The House of Representatives continues to work on the bill. Yesterday, the House Rules Committee cleared for floor consideration an amendment to the bill (H.R. 1628) which would create an invisible high risk pool to help insurers cover the cost of expensive members in the individual market.  The FEHBlog listened to the Speaker’s press conference announcing this change. One of his colleagues explained that the concept was successfully tested in the State of Maine. Here’s a link to a Health Affairs blog article about this experiment.

The House also passed this week by a wide bipartisan margin a bill that would clarify that employers may use stop loss insurance to help them control similar costs in self-funded arrangements without losing the benefits of ERISA preemption of state mandates and related laws. Employee Benefits News discusses the bill here.

On the disease front:

• NPR provides an update on the Zika virus’s impact on expectant mothers in our country. 
• Health Day reports that “Overall cancer death rates in the United States continue to fall, but racial gaps persist, a new report says.”  Take a look. 

On the prescription drug front,

Congress remains in session again on Capitol Hill this week. The Supreme Court is likely to be back to nine justices later this week when the Senate confirms Judge Neil Gorsuch. The vote is scheduled for Friday.

Congress is under pressure to pass a resolution by April 28 funding the federal government though the end of the federal fiscal year on September 30.  The FEHBlog cannot imagine a federal shutdown occurring when the same party hold the Presidency and both Houses of Congress.  But as we were once again reminded by the demise of the American Health Care Act earlier this month, we don’t have a parliamentary system.

The FEHBlog has been keeping an eye on the House bipartisan postal reform bill (H.R 756).  Any action since the House Oversight and Government Reform Committee approved the bill by voice vote on March 16 has been behind the scenes.  Printing Impressions reports that last week postal customers from the printing, imaging, and mailing industries visited Capitol Hill last week to urge fast approval of the bill.

In a bit of good news, ABC News reports that progress is being made on the development and testing of a vaccination against the Zika virus.  According to the report,

This is a totally new kind of vaccine. Traditionally, vaccines are made using a dead or weakened virus to train the body’s immune system to recognize and fight that infection.
In contrast, the DNA vaccine works through trickery: It’s made with a circular piece of DNA carrying genes from the Zika virus that, once in the body, make particles that resemble Zika enough to alert the immune system but cannot cause infection.
The NIH also is testing the safety of some more traditional Zika vaccine candidates, but the easier-to-make DNA vaccine was the first ready to advance to this second stage of human testing.
Don’t expect a vaccine to be widely available any time soon. If Zika causes lots of illness this year, Fauci said researchers may have clues by early 2018 about how well the shots work — but if natural infections slow, they’ll need many more volunteers to get an answer.

Here’s a link to the Week in Congress’s report on the current week’s activities on Capitol Hill. Yesterday, the Senate Health Education Labor and Pensions Committee cleared for floor consideration the President’s nomination of Alexander Acosta to be Secretary of Labor. “An aide for Senate Majority Leader Mitch McConnell told Bloomberg BNA March 30 that he didn’t have any scheduling announcements about a full floor vote.”

Healthcare Dive is reporting this afternoon that “Donald Rucker, who previously served as Siemens Healthcare’s vice president and chief medical officer, will serve as the next head of the HHS’ Office of National of Coordinator for Health IT (ONC).” “On his LinkedIn biography, Rucker describes himself as a physician leader with national clinical informatics success.” He states he was a co-developer of the first Microsoft Windows-based electronic medical record.” That’s good news because no doubt he will be leading the charge on electronic medical record interoperability.

Health Data Management tells us about a recent IBM report on the state of health care cybersecurity. “The top types of attacks for monitored security clients in 2016 were injection of malicious data (/ phishing attacks experienced by 42 percent of its clients), manipulation of data structures to gain unauthorized access (32 percent) and collection/analysis of information (9 percent).”  The oversight subcommittee of the House Energy and Commerce Committee will be holding a hearing on strengthening public/private partnerships to guard against cyberattacks in the health care sector next Tuesday.

GAO issued a report on the benefits and limitations of identity theft services for consumers.

Finally, be sure to read this Forbes article in which the CEO of the enormous Permanente Medical Group, Robert Pearl, MDm describes his recent hospital stay following a serious knee injury. The article begins

I’ve spent much of my life in hospitals as a physician and surgeon. Recently I suffered an injury that taught me much about what it’s like to be a patient. It wasn’t that I did not understand the problems, but now I recognize the full magnitude. As a result, my perception of being hospitalized has changed forever. And I recognize how delirium, a life-threatening event, can happen to even relatively healthy patients.

Historically, OPM issues a call letter for benefit and rate proposals in March shortly before the carrier conference. This year, likely due to the impending Administration change, OPM issued the 2018 call letter in early January. In the FEHBlog’s view if OPM is going to issue the call letter early then why not issue a draft call letter for carrier comment like Medicare Advantage does? 

Congress remains at work on Capitol Hill this week. Here is a link to the Week in Congress’s report on last week’s activities on Capitol Hill. The FEHBlog did notice that the U.S. Senate has freshenened up its website.

Here are a few tidbits from last week’s OPM AHIP FEHBP carrier conference:

• OPM’s medical director, Dr. Christine Hunter, received a prestigious Presidential Rank award from President Obama last December. What’s more, OPM’s FEHBP tribal coverage desk received a Presidential customer service award.  Mazaal tov! 21,000 Indian tribal employees who work for 100 tribes are covered under the FEHBP. 
• A National Business Group on Health speaker called attention to his group’s issue brief on specialty pharmacy costs. In that regard, a CVS medical director predicted that the biosimilar market will “take off” in three to four year. The FEHBlog certainly hopes so. 
• OPM’s unlocktalent.gov is a data visualization tool that’s
  available to the public.  The tool
  includes Federal Employee Viewpoint Survey and the Enterprise Human Resources
  Integration database.  To see the publicly available information, you need to scroll down the home page.  There’s a United States map that shows where federal employees live, for example. Federal employees can register for a deeper dive. 

The Trump administration has named Roger Severino as the new director of the Department of Health and Human Services’ Office for Civil Rights, which enforces HIPAA[‘s Privacy and Security rules] and protects patients rights.
An OCR spokesperson confirmed on March 24 that Severino had been named to the position, and his bio has been posted on the office’s website.
Meanwhile, former Rep. John Fleming, R-La., has reportedly been selected for the newly created position of deputy assistant secretary for health technology. It’s not yet clear whether Fleming would lead HHS’ Office of the National Coordinator for Health IT. ONC oversees standards and policies for the HITECH Act electronic health records “meaningful use” financial incentive program, and also carries out various health IT-related provisions in the 21st Century Cures Act, which was signed into law last year.

Finally, Fierce Healthcare reports that last week, the Centers for Medicare and Medicaid Services announced that the agency is delaying at least until October 1, 2017, the mandatory Medicare bundled payment programs that the Obama Administration rolled out last year.  “The latest delay came as welcome news to the Federation of American Hospitals and the American Hospital Association, which expressed concern last year that the accelerated pace of the program.”

We’re going to be living with Obamacare for the foreseeable future,” though he argues that replacing it would actually have done a favor to Democrats.  He says that tax reform will move forward, even though the plan has been complicated by the Obamacare taxes remaining in place.

The Journal further reports that

Going forward, [President] Trump said he would seek bipartisan support for a bill to overhaul the health-care system, saying that would be “the ultimate” and drawing a contrast with the Affordable Care Act, which he said was “rammed down everyone’s throat” with only Democratic support.

Also today, a three judge panel of the U.S. Court of Appeals for the D.C. Circuit heard oral argument in the Anthem / Cigna appeal of the district court decision blocking their merger agreement from closing. The Wall Street Journal reports

A federal appeals court panel on Friday asked tough questions of health insurer Anthem Inc., which is attempting to salvage its proposed $48 billion acquisition of Cigna Corp. after a trial judge blocked the combination as anticompetitive.
The Anthem appeal, which took place in front of a large crowd at the U.S. Court of Appeals for the District of Columbia Circuit, was surprisingly lively—and lengthy—as three judges said the case presented novel and difficult issues.
“We haven’t had a case like this,” Judge Brett Kavanaugh said.
The session was supposed to last for 40 minutes; the judges instead asked questions for about two hours.

That’s an engaged panel. This case was expedited so that the panel could issue its decision before the Anthem – Cigna merger agreement’s termination date – April 30, 2017.

Over the weekend, the FEHBlog will share some bon mots from the FEHBP carrier conference. Nothing earthshaking occurred but some useful tidbits were shared by the speakers.

Tomorrow, the seventh anniversary of President Obama signing the Affordable Care Act into law, the House of Representatives is expected to vote on the American Health Care Act.  The legislative process is quite engaged this evening according to the press.

Today the House of Representatives passed two healthcare related bills — a Small Business Healthcare Fairness Act (HR 1101) and a Competitive Health Insurance Act (HR 372).  The first bill would permit small businesses to purchase health insurance coverage through association health plans.  The second would subject all health insurers to the full application of federal anti-trust laws.  Whether the first bill passes the Senate is anyone’s guess, but the second bill is a slam dunk to become law in view of the 416-8 vote for House passage. More details on the first bill can be found in Kaiser Health News, and more detail on the second bill can be found in Bloomberg BNA.

Let’s tie up a couple loose ends

• As the OPM IG was walking out the door just about a year ago, he tossed a grenade into the acting Director’s office by asserting that Ms. Cobert should have stepped down when President Obama nominated her to serve as permanent OPM director. The OPM IG relied on a DC Circuit decision called NLRB v. SW General, 796 F.3d 67. As the FEHBlog noted at the time, the D.C. Circuit opened the Director’s actions to legal challenge but did not render all of her actions illegal per se.  In any event, on Monday, in a 6-2 decision written by the Chief Justice, the Supreme Court affirmed the D.C. Circuit decision. 
• Five years ago, a major health care crisis erupted when the New England Compounding Center was accused of causing 2012 fungal meningitis outbreak that killed 64 people and hurt more than 700.  The crisis was attributed to 14,000 contaminated vials of drugs that NCCC had prepared and distributed nationwide. Following the crisis, Congress passed a law cracking down on compounding pharmacies.  NPR reports that today a federal district court jury in Boston found one of the NECC owners guilty of racketeering but not murder.
   

Tomorrow also is the beginning of the annual AHIP-OPM FEHBP carrier conference.  The FEHBlog will be there.

Yesterday, the House of Representatives leadership released a set of AHCA amendments.  The House Speaker Paul Ryan explained that

The first amendment makes technical revisions to the original bill to ensure compliance with the Senate rules governing reconciliation bills. It is purely technical and achieves the same policy goals as previously drafted.
The second amendment includes improvements drafted by both of the authorizing committees.
Under jurisdiction of the Ways and Means Committee: Moves up repeal of Obamacare taxes from 2018 to 2017, strikes a provision allowing excess tax credits to be deposited into Health Savings Accounts, and provides budgetary space for the Senate to increase tax credits for older Americans.
Under jurisdiction of the Energy and Commerce Committee: Immediately prohibits any additional states from expanding the current broken Medicaid program, allows states to opt-in to a traditional Medicaid block grant as well as implement work-requirements for Medicaid, protects the equitable state-federal partnership, and enhances the growth rate for the aged and disabled population on Medicaid. 

It will be a busy week on Capitol Hill with four days of confirmation hearing for Supreme Court justice nominee Neil Gorsuch before the Senate Judiciary Committee beginning tomorrow and a House of Representatives vote on the American Health Care Act scheduled for Thursday.   Here is a link to the Week in Congress’s one pager on last week’s activities on the Hill.

The American Enterprise Institute features an article on the economic lessons that can be drawn from pricing trends in cosmetic surgery over the past 20 years.  Of course, as we all know, the cost curve for health care services has been up over the period. According to the article health care inflation rivals college education inflation.  Cosmetic or plastic surgery is paid out of pocket by the patient with no health benefits coverage and no income tax deduction, except in limited circumstances.  The author compared average cost increases in general health care to cost increases in cosmetic surgery.

The average price increase between 1998 and 2016 for the [top] 20 cosmetic procedures displayed above was 32%, which is less than the 47.2% increase in consumer prices in general. Of the 20 procedures above, 14 increased in price by less than overall inflation (and therefore decreased in real terms) and only six increased in price by more than inflation. And most importantly, none of the 20 cosmetic procedures in the table above have increased in price by anywhere close to the 100.5% increase in the price of medical care services or the 176.7% increase in hospital services since 1998. 

The Affordable Care Act exacerbated this trend by mandating the coverage of a multitude of low priced services and items.  Hopefully, the American Health Care Act and HHS will allow health insurers and consumers more flexibility going forward.

The FEHBlog is anxiously awaiting the annual FEHBP carrier conference sponsored by OPM and AHIP. The conference will be held on Thursday and Friday of this week in beautiful Crystal City, Virginia.