Monday Musings

Monday Musings

Today’s U.S. Supreme Court order list from its February 21 conference made no mention of the Texas v. U.S. cases (Nos. 19-840 and 19-841) concerning the Affordable Care Act’s constitutionality, one way or the other. This means that the Court will take up (or continue consideration of) the cases at a later conference. At this stage the Court is deciding whether to review the Fifth Circuit’s decision now or wait for further proceedings in the lower courts. The Court’s docket sheet states that the cases have been re-distributed for the February 28, 2020, conference.

The Federal Employees Dental and Vision Programs’ (“FEDVIP”) laws requires OPM to bid out all of the FEDVIP contracts every seven years. Currently OPM has contracted for 10 FEDVIP dental plans and four FEDVIP vision plans. Last week, OPM released its request for proposals for the next seven year FEDVIP contract cycle which begins on January 1, 2021. OPM states in the RFP document that it has capped the upper limit of dental plans at 12 and vision plans at 5. The deadline for submission of proposals is March 23, 2020. OPM expects to announce the successful contractors in May.

The Washington Post reports that the focal point of the national drug overdose crisis has shifted to the California and other western states. The drugs causing overdose deaths are principally two illicit drugs — fentanyl and methamphetamine.

In California, fatal drug overdoses over the previous 12 months increased 13.4 percent between July 2018 and July 2019, the last month for which the CDC has compiled provisional data — an additional 728 deaths.

Fentanyl delivers an immediate, powerful high but can also render the user unconscious and unbreathing almost instantly. * * * [San Francisco based harm reduction worker Kristen Marshall] noted that thousands of overdoses have been reversed by peers on the street who were supplied with naloxone as part of harm reduction efforts. For many years, San Francisco saw a growing population of drug users but had a strikingly low rate of fatal overdoses. But that was before fentanyl showed up.

In contrast, Illinois’ fatal drug deaths were down 8 percent, Pennsylvania’s down 10 percent, Michigan’s down 13 percent and Maine’s down 20 percent.

Thursday Miscellany

Fedweek noticed another tidbit in the agency’s FY 2021 budget that’s worth noting :

OPM is seeking authority from Congress to offer federal employees what it calls “voluntary benefits” such as short-term disability insurance, prepaid legal plans, emergency short-term childcare, and personal accident insurance.

The purchasing employee or annuitant would be responsible for paying 100% of the premiums for these coverages. What’s more the FEHBlog knows that prepaid legal plans cannot be offered on a pretax basis like FEDVIP can.

In other news,

  • Milliman posted an interesting infographic on various aspects of organ transplantation in the U.S. Average wait times are up and survival rates are down. That’s puzzling.
  • Healthcare Dive reports that “The [federal] Health Information Technology Advisory Committee on Wednesday unanimously approved its second annual report to Congress on the state of health IT landscape, recommending fixes to improve the electronic access, exchange and use of medical information.”
  • The Centers for Disease Control announced today that this year’s flu vaccine is having an efficacy rate of 45%.
  • Health Affairs offers an interesting study on the impact of administrative costs on U.S. healthcare spending.

Big Monday

The U.S. Office of Personnel Management (“OPM”) released its call letter for 2021 FEHBP benefit and rate proposals today. The carrier proposals are due on Sunday May 31, 2020. To prepare the proposals carriers also need OPM’s technical guidance, which is a separate Carrier letter, and to submit their proposals, carriers also must complete OPM’s extensive “ADC” information request. OPM expects a lot from its FEHBP carriers.

The President did transmit his FY 2021 budget proposal to Congress today. The Administration intends to propose to statutory change to the FEHBP government contribution formula (5 USC Sec. 8906):

to base it on a plan’s score from the FEHB Plan Performance Assessment would improve healthcare quality and affordability within the program. The enactment of the proposals in 2021 will not begin to impact program financials until 2023. [Page 1168]✦

This appears to be a retread from the last budget cycle. However, the FEHBlog does not recall reviewing the proposed legislative language for the 2019 proposal. This proposal assuming its the same one didn’t get very far then, and it’s unlikely to get further this year in the FEHBlog’s view. Federal News Network discusses other federal employee compensation found issues in the budget proposal.

Russ Roberts the host of the Econtalk podcast held a fascinating conversation with “physician and author Marty Makary of Johns Hopkins University talks about his book The Price We Pay.” The book concerns fixing our healthcare system. Dr. Makary made a lot of sense to the FEHBlog. He encourages readers to listen to this podcast or read the transcript.

Thursday Miscellany

At last year’s OPM AHIP FEHBP Carrier Conference, a Centers for Disease Control scientist announced that the U.S. Surgeon General soon would be issuing a new comprehensive report on tobacco use in the U.S. That report was issued today. It

  • Examines the effectiveness of various smoking cessation tools and resources;
  • Reviews the health effects of smoking and catalogues the improvements to health that can occur when smokers quit;
  • Highlights important new data on populations in which the prevalence of smoking is high and quit rates are low; and
  • Identifies gaps in the availability and utilization of programs, policies, and resources that can improve cessation rates and help smokers quit.

Here’s a link to OPM’s Quit Smoking website which discusses the FEHBP generous tobacco cessation benefits.

The CDC updated the public on its important antibiotic resistance solutions initiative.

CDC’s AR Solutions Initiative invests in national infrastructure to detect, respond, contain, and prevent resistant infections across healthcare settings, food, and communities. CDC funding supports all 50 state health departments, six local health departments, and Puerto Rico and the U.S. Virgin Islands.  Through these investments, CDC is transforming how the nation and world combat and slow antibiotic resistance at all levels.

Good luck.

The FEHBlog has discussed the relatively new, cooperative effort of hospitals to create a public asset, known as Civica Rx, to help solve drug shortages and lower the cost of generic drugs. Today, Civica Rx and the Blue Cross Blue Shield Association announced

their partnership to create a new subsidiary dedicated to lowering the cost of select generic drugs. The subsidiary is being formed in response to the impact of high drug costs on the health of Americans and the overall affordability of health care. Other health plans, employers, retail partners and health care innovators who share the belief that patients and their needs come first are invited to join the initiative.

The subsidiary will acquire and develop Abbreviated New Drug Applications (ANDAs) for select generic drugs and partner with Civica and manufacturing partners to bring more affordable generic drugs to uncompetitive markets in exchange for aggregated volume and multiyear purchasing commitments. Initially, several generic medications identified as having high potential for savings will be prioritized by the partnership and will evolve into a platform that can be used to enhance competition for additional generic drugs.

The new operation expected to start delivering product in early 2022. Strong move.

The American Hospital Association now offers a webpage with updates and resources concerning the Wuhan coronavirus.

Midweek update

CVS announced the following six health trends for 2020

  1. Continued evolution in kidney care 
  2. Greater consumer scrutiny on wellness products 
  3. The need for data stewardship as digital health rolls on 
  4. Pharmacies as a tool to reach underserved populations 
  5. Efforts to mitigate loneliness 
  6. Increased transparency around drug pricing 

The Centers for Medicare and Medicaid Services has decided to extend Medicare coverage to acupuncture for chronic low back pain as an alternative to opioid based pain killers. The CMS decision ” will cover up to 12 sessions in 90 days with an additional 8 sessions for those patients with chronic low back pain who demonstrate improvement.” Previously Medicare excluded acupuncture from coverage.

Retired OPM official Reg Jones discusses survivor benefits related to federal employment in Fedweek. FEHBP survivor benefits are generous if the prerequisites are met:

If your spouse receives an annuity in any amount and was covered under either the self plus one or self and family option of your FEHB plan, he or she and all eligible children may continue coverage. If the annuity amount is less than the premiums required, your spouse will be able to directly make payments to cover the rest of the cost.