The Courageous 4 Becomes The Courageous 17
The House voted 230-196 to extend enhanced Exchanges premium subsidies for three years as is, with 17 GOP lawmakers joining Democrats. This was after four GOP members signed on to a discharge petition to force a vote. House Speaker Mike Johnson, R-LA, and other leaders are livid, but the members were courageous to buck their party to cast a vote they believed in. They tried very hard to get the GOP leaders to agree to a compromise and even simply to hold a vote. Johnson broke his word on the vote under pressure from head-in-the-sand conservatives.
The measure is not expected to pass the Senate as a similar bill failed to reach 60 votes there, but a compromise continues to be negotiated in the upper chamber between moderates on both sides of the aisle, which then would face a rocky road back in the House with the GOP leaders. I have predicted chances at best are 50-50. I covered the details of a potential compromise in the newsfeed yesterday. The vote today certainly helps on the momentum front.
Additional articles: https://www.healthcaredive.com/news/house-votes-revive-enhanced-aca-subsidies/808871/ and https://www.modernhealthcare.com/politics-regulation/mh-aca-subsidies-house-vote-insurance/ and https://www.medpagetoday.com/publichealthpolicy/washington-watch/119347 and https://thehill.com/homenews/house/5680184-obamacare-tax-credits-bill-passes-house/ and https://thehill.com/homenews/senate/5679302-democrats-push-thune-obamacare-vote/ and https://www.beckershospitalreview.com/finance/house-approves-3-year-aca-subsidy-extension/
(Some articles may require a subscription.)
#exchanges #healthcare #coverage
Anthem Sues Over No Surprises Abuse
Anthem’s California companies are suing 11 Prime Healthcare facilities. Anthem says the providers filed fraudulent No Surprises Act arbitration cases and have flooded the process. It says more than 6,000 ineligible claims were submitted to the independent dispute resolution process, which resulted in the providers being paid $15 million more than entitled.
The suit parallels other suits filed by major health plans, including Elevance Health, Anthem’s parent, in other states. The process is badly abused by certain providers and needs reform. It is driving up price and costs.
#nsa #nosurprisesact #pricetransparency
340B Reform Pilot Remains Stalled
A three-judge federal appellate panel denied the federal government’s appeal of a district court decision temporarily blocking the launch of a 340B program reform pilot that would introduce retrospective rebates vs. upfront discounts. The panel agreed with the lower court ruling, finding the government did little to support its claim that an experimental program requires less justification than a permanent change.
Additional article: https://www.fiercehealthcare.com/providers/hospital-groups-file-lawsuit-enjoin-pharma-supported-340b-rebate-pilot
#340b #drugpricing #branddrugmakers #hospitals
https://www.healthcaredive.com/news/340b-rebate-pilot-paused-trump-hrsa-aha-lawsuit/808707
C-SNPs Could Face Reforms
An article in Modern Healthcare states that Chronic Care Special Needs Plan (C-SNPs) could be required by the Centers for Medicare and Medicaid Services (CMS) to be Medicaid managed care contractors. This parallels recent reforms covering Dual Eligible SNPs (D-SNPs).
CMS suggested it wanted reforms in a recent draft rule covering Medicare Advantage (MA) plans. C-SNPs have grown dramatically since “look-alike” D-SNPs were significantly reined in. CMS is very concerned about the growing number of dual eligibles in C-SNPs and not subject to the protections of tougher D-SNP regulations. About 80% of MA SNP enrollees are in D-SNPs, with most of the remainder in C-SNPs.
(Article may require a subscription.)
#snps #medicareadvantage #dualeligibles
https://www.modernhealthcare.com/insurance/mh-medicare-advantage-c-snp-medicaid-managed-care
House GOP To Hold Affordability Hearings
Following President Trump’s announcement that he will call in 14 health plan companies to grill them on affordability, House Republicans on Thursday said they are summoning top insurers to testify later this month as part of a series of affordability hearings. They will appear before the House Energy and Commerce and Ways and Means committees.
#healthcare #coverage #affordability
https://thehill.com/policy/healthcare/5679511-house-gop-health-insurance-execs-affordability
— Marc S. Ryan
