FEHBlog

The FEHBlog is back inside the Beltway after a relaxing week on the outer banks of North Carolina.

Congress is in session this week.  Here’s a link to the Week in Congress’s report on last week’s actions on Capitol Hill.

We may see a vote on the Better Care Reconciliation Act in the Senate. Check out Avik Roy’s interesting take on the CBO reports on the ACA repeal and replace law.  He explains that the CBO large losses in coverage represent an expectation that people won’t buy coverage unless they are forced to do so. Personal responsibility is such an important aspect of healthcare.  Give people more consumer choice in the health insurance market.

The FEHBlog was saddened to read about the unexpected death of Wall Street Joural editorial writer Joseph Rago. He was only 34 years old. He had won a Pulitizer Prize in 2011 for his editorials on the Affordable Care Act. The FEHBlog, in addition to reading the WSJ, frequently listened to him on podcasts and the weekly WSJ editors show on Fox News. Mr. Rago wrote on March 20, 2010, at the time Congress passed the ACA that

In our world of infinite wants but finite resources, there are only two ways to allocate any good or service: either through prices and the choices of millions of individuals, or through central government planning and political discretion. This choice is inexorable. Stripped of its romantic illusions, ObamaCare is really about who commands the country’s medical resources. . . .

If Congress does pass a repeal and replace law, Mr. Rago deserve credit for that action.

Finally, here’s a link to an insightful Politico article about the connection between tax exempt hospitals, which group represents the majority of U.S. hospitals, and the ACA.

The Senate Budget Committee posted a July 20 discussion draft of the Better Care Reconciliation Act today. CBO announced that it would be updating its projections for the new draft.

The federal government posted its 2017 updated semi-annual regulatory agenda today.

The Agenda represents ongoing progress toward the goals of more effective and less burdensome regulation and includes the following developments:

• Agencies withdrew 469 actions proposed in the Fall 2016 Agenda;

• Agencies reconsidered 391 active actions by reclassifying them as long-term (282) and inactive (109), allowing for further careful review;

• Economically significant regulations fell to 58, or about 50 percent less than Fall 2016;

• For the first time, agencies will post and make public their list of “inactive” rules-providing notice to the public of regulations still being reviewed or considered.

Here’s a link to OPM’s agenda which includes several FEHBP items.

Axios has an interesting report on where the current state of healthcare re-reform after four Senators came out against the Better Care Reconciliation Act on Monday thereby causing Senate Majority Leader McConnell to fall short on the vote count.

All of the Republican senators who oppose the Senate health care bill are meeting tonight to work out their differences — after being told by President Trump this afternoon that they need to work late into the night to get a deal. The holdouts, including moderates and conservatives, are scheduled to meet in Sen. John Barrasso’s office at 7:30 pm Eastern with the goal of getting a deal to revive the shelved Affordable Care Act repeal and replacement bill, according to sources with direct knowledge of the discussions.

The Congressional Budget Office reported as the FEHBlog has been typing this out that “Later today, CBO and the Joint Committee on Taxation (JCT) will release estimates of the effects of the [Senate’s] Obamacare Repeal Reconciliation Act of 2017.

Meanwhile, the House Budget Committee is working on an FY 2018 budget resolution. A markup hearing was held today.  Federal News Radio reports on the budget resolution’s impact on federal employees and annuitants. Modern Healthcare further informs us that

The House Budget Committee on Wednesday agreed [at its markup hearing] to bake in hundreds of billions in Medicaid cuts from its ACA repeal bill to the budget resolution, plus an additional $114 billion in cuts over 10 years.
The committee’s Republicans’ unanimously approved the decision with no Democrats on board. The budget resolution, which is the foundation for passing tax reform in the Senate without Democratic votes, also assumes Medicare will reduce spending by $487 million from 2018 to 2027.
Some of the additional savings would come from imposing a work requirement on Medicaid adult beneficiaries who are younger than 65 and are not on Social Security disability as a condition of eligibility.

 The resolution now heads to the House floor.

On the disease front, the American Hospital Association tells us that

An estimated 12.2% of U.S. adults had diabetes in 2015, including one in four aged 65 and older, according to the latest national estimates released by the Centers for Disease Control and Prevention. Nearly one-quarter of the 30.2 million adults with diabetes were not aware they had it, based on data from the National Health and Nutrition Examination Survey and Census Bureau. Fasting glucose and hemoglobin A1C levels were used to derive estimates for undiagnosed diabetes and prediabetes. About one-third of adults (84.1 million) had prediabetes, blood glucose levels at risk of progressing to diabetes, including nearly half of adults aged 65 and older. “Consistent with previous trends, our research shows that diabetes cases are still increasing, although not as quickly as in previous years,” said Ann Albright, director of CDC’s Division of Diabetes Translation. “Diabetes is a contributing factor to so many other serious health conditions. By addressing diabetes, we limit other health problems such as heart disease, stroke, nerve and kidney diseases, and vision loss.”

Those are startling numbers.  Meanwhile that Washington Post reports on an ongoing study that is suggesting that the use of PET scans can significantly improve of the accuracy of Alzheimer Disease diagnoses.

The FEHBlog forgot to link to the BNA article about the missing in action Spring 2017 federal semi-annual regulatory agenda. The article notes that the agenda will be posted on reginfo.gov this week and it will reflect the impact of the 2 out in 1 in executive order.  Currently that website will not pull up so the government may be adding the new agenda now. The FEHBlog will check back tomorrow as duty calls.

Congress remains in session this week on Capitol Hill. Here’s a link to the Week in Congress’s report on last week’s actions there.

Due to Senator John McCain’s unexpected hospitalization, the Senate will not be voting on the Better Care Reconciliation Act this week.  Reuters also reports that the Congressional Budget Office will take a little more time to prepare its report on that bill.

Last week, the Social Security and Medicare trustees issued their annual report. The Associated Press reads the tea leaves to find that Social Security recipients should receive a 2.2% cost of living adjustment for 2018, which surpasses 2017’s 0.3% increase and 2016’s no COLA.  The trustees also “project that Medicare Part B premiums will remain unchanged — $134 a month for most, though retirees with higher incomes pay more.” Federal annuitants receiving CERS benefits and recent annuitants may see higher Part B premiums than others because of the exceptions to the law which generally protects annuitants against sharp increases in Part B premiums. “Both Social Security’s cost-of-living adjustment and the Medicare Part B premium are to be announced in the fall.”

Last week, the Missouri Supreme Court finally came to its senses and came into line with the U.S. Supreme Court’s April 2017 decision holding that the FEHB Act, 5 U.S.C. Sec. 8902(m)(1), preempts  state laws purporting to interfere with the subrogation and reimbursement rights of FEHB plan carriers. The third time was the charm for this court.

Hey, France did help us win the Revolutionary War!

It has been a busy week.

Yesterday, the Centers for Medicare and Medicaid Services announced proposed calendar year 2018 payment policies for outpatient hospital / ambulatory surgical care and physician services under Medicare. The CMS administrator, Seema Verma, notes in these announcements that CMS is looking to relieve regulatory burden on providers and help improve the provider / patient relationship among other goals.

Speaking of relieving regulatory burden, Wednesday was the comment deadline on CMS’s request for public comment on “Reducing Regulatory Burdens Imposed by the Patient Protection and Affordable
Care Act and Improving Healthcare Choices to Empower Patients.”  Here a links to a potpourri of interesting comments — AHIP, U.S. Chamber of Commerce, American Benefits Council, NCQA, United Health Group, and CVS Health Care.

Healthcare Dive reports on a JAMA study finding that traditional Medicare and Medicare Advantage plans pay doctors just about the same amount. Private sector plans, including FEHB plans, pay more, which illustrates cost shifting from Medicare to everyone else (except Medicaid which also cost shifts).  If we went with a Medicare for All program, there would be no place left to shift costs. The FEHBlog does not understand why providers can’t seem to comprehend this fact.

Health Data Management tells us that the Trump Administration wants to improve the utility and interoperability of electronic medical records. Good luck with that

Healthcare Dive reports on “the largest healthcare fraud takedown in history.  The Boston Globe’s STAT reports  that Attorney General Jeff Sessions is implementing a crack down on opioid related fraud specifically.

CBS reports that a  form of gene therapy treatment known as CAR-T is working its way through the FDA approval process. This particular treatment is aimed at advanced leukemia in children and young adults.

The therapy could be the first of a wave of treatments custom-made to target a patient’s cancer. Called CAR-T, it involves removing immune cells from a patients’ blood, reprogramming them to create an army of cells to recognize and destroy cancer and injecting them back into the patient.

The final stage in the new drug approval process should be reached later this year. Yippee.

Here’s a link to a law professor’s take in Forbes on the revised BRAC.  The article mentions that Sen. Lindsay Graham (R SC) is submitting his own ACA repeal and replace bill that would repeal the individual and employer mandates and funnel all of the ACA funding to the States for local healthcare use.

According to a Wall Street Journal podcast, the Senate majority will be discussing the revised BRAC over the weekend while they wait for the Congressional Budget Office report. The next step is to hold a floor vote on whether to proceed with consideration of the bill.  That requires 50 votes in this case because it’s a reconciliation bill. If that succeeds and the Senate majority can only afford to lose two Republican Senators on any vote, then the bill will be open for consideration of amendments followed by a final vote unless the Senate majority leadership pulls back the bill.

The FEHBlog does not know where this Republican initiative is headed.  The FEHBlog is concerned that if the initiative fails, the ACA health insurer tax may revive for 2018 (unless Congress separately addresses the issue) and thereby drive up FEHBP premiums.  If successful, this initiative, in addition to eliminating these onerous fees, would improve the offerings of consumer driven plans and allow OPM to return the flexible spending account maximum to $5000.  In the FEHBlog’s view, it also would be helpful if OPM would allow carriers more flexibility in benefit design but that can be done administratively whether or not the Republican initiative passes.

The Washington Examiner reports this morning on a leadership summary of the revised bill which will be released at 11:30 am ET today. It’s interesting reading.

The FEHBlog was pleased to read that the Senate leadership has decided to extend the current session for two weeks, thereby reducing the August recess from five weeks to two weeks.  Not only does the Senate have to address the health care bill, but there also is a growing backlog of Trump nominations such as the OPM director and deputy director, that is building up and Congress needs time to resolve deficit ceiling and FY 2018 appropriations issues.

It’s best not to make predictions about Congressional actions. A year ago and six months ago, the FEHBlog was swearing up and down that Congress was poised to pass postal reform. But no dice. Similarly, the FEHBlog wrote last winter about a bill (H.R. 372) that flew through Congress with nearly unanimous support to remove the federal antitrust law exemption from health insurers. This occurred right around the time that Aetna and Anthem were losing their antitrust cases so it was a bit puzzling to the FEHBlog. In any event this morning the FEHBlog heard a radio interview with Rep. Louie Gohmert (R TX) who was troubled by the fact that this bill has not gone anywhere in the Senate. Rep. Gohmert also criticized a tort reform bill (H.R. 1215) that the House passed last month on Tenth Amendment grounds. More practically he was concerned that if Congress set this precedent, the Democrats would seek to undo state tort reform laws when they eventually hold the gavel again. Interesting.

And in straightforward good news —

• Modern Medicine interviews Cigna’s chief medical officer about the company’s successful efforts to reduce opioid prescriptions to their plan members by approximately 12% over the past year.
• Fierce Healthcare interviews Aetna’s chief of medical strategy about the company’s strategic partnership with the U.S. Centers for Disease Control to reduce the overprescription of antibiotics. 

Congress returns to Capitol Hill from its week long Independence Day recess tomorrow.

The Wall Street Journal keeps presenting interesting articles about the Crispr technology. That technology works as follows:

An enzyme called Cas9 can be programmed to latch onto any 20-letter sequence of DNA. Once there, the enzyme cuts the double helix, splitting the DNA strand in two. Scientists supply a snippet of genetic material they want to insert, making sure its ends match up with the cut strands. When the cell’s repair mechanism kicks in to fix the cut, it pastes in the new DNA.

The weekend issue included an interview with “[Professor] Jennifer Doudna, a Crispr pioneer who runs a lab at the University of California, Berkeley.” Ms Doudna states “I frankly have been flabbergasted at the pace of the field.  We’re barely five years out, and it’s already in early clinical trials for cancer. It’s unbelievable.” Ms. Doudna and a colleague just released a book called A Crack in Creation. Both the book and the article look at the related ethic issues created by the technology.

Tonight the Journal reported that “A holder of [22] key patents to the Crispr gene-editing technology [the Broad Institute of MIT and Harvard] is willing to join a world-wide joint patent pool—a development that medical and legal experts think could hasten the development of new human therapies.’

The Boston Globe reported today about a criminal scheme involving drug rehabilitation facilities.

Patient brokers, some of whom are themselves in recovery from drug addiction, are paid by marketers working for treatment centers eager to sign up patients with private insurance plans. 

The brokers use phony addresses to sign up people immediately [on healthcare.gov] — a change of address is an exception to the usual limitation that customers can sign up only during the end-of-year open enrollment period — and to take advantage of the best-paying PPO plans in states in which they don’t live. 

The brokers, patients’ families, or marketers for the treatment centers pay the insurance premium. Within a few weeks, the insurer is billed tens of thousands of dollars for what is often subpar care.