|HHS Secretary Alex Azar has been almost singularly focused in delivering on the administration’s promises to increase transparency and lower prescription drug prices since President Trump released his American Patients First blueprint in a Rose Garden ceremony a year ago. The blueprint offered nearly 30 policy recommendations to modernize payment policies, including bringing down out-of-pocket costs for patients. Just last week, HHS issued a final rule to give patients and doctors more tools to monitor and control costs in Medicare. For example, after a start-up period, Medicare Part D plans will be required to provide doctors and other prescribers access to price information for different prescription drugs when they are writing the script.|
|Short-Term Limited-Duration Insurance (STLDI), which is exempt from ACA rules, survived as a viable competitive market, offering health coverage priced in proportion to individuals’ risks. But it has been disparaged as “junk insurance” that fails to cover adequate provider networks, offers only catastrophic coverage, makes essential benefits unavailable, helps only young and healthy individuals, undermines protections for those with preexisting conditions, and causes premiums for plans on the ACA’s exchange to soar. This study of the STLDI market finds that each of these claims is false. For equivalent insurance protection, the premiums for STLDI plans are lower than—in some cases, almost half the cost of—premiums on the exchange. The savings to be gained from switching to STLDI are even greater for more comprehensive insurance coverage.|
The Trump administration has been working behind the scenes for months on a strategy to force greater price disclosure across much of the $3.5 trillion health-care industry. The push relies on existing administrative tools, according to people familiar with the discussions. Those include Labor Department powers under the law setting minimum standards for private-industry health plans and current hospital-payment rules under Medicare. The administration is strongly interested in forcing insurers to publicize the negotiated rates they pay for services, the people said. The requirement could affect insurers providing coverage in the private-employer market.
The Trump administration announced that it has finalized a new rule requiring all drug companies to include the list prices of their drugs in direct-to-consumer advertisements. If sunlight is the best disinfectant, the White House hopes that more visibility about drug prices will hold drugmakers more accountable and reduce costs for patients at the pharmacy counter.
President Trump announced Thursday his administration is working with Congress on a comprehensive legislative package to outlaw crippling surprise medical bills. The administration says it is aiming to increase transparency in health services billing. The president said that patients must be told ahead of treatment if a specialist, such as an anesthesiologist or radiologist, is out of their network. Patients should only be billed for out-of-network care if they consent to receiving treatment. “These bills have ruined people’s lives,” Trump said at the White House.
The Trump administration formally declared its opposition to the entire ACA on Wednesday, arguing in a federal appeals court filing that the signature Obama-era legislation was unconstitutional and should be struck down. The filing was made in a case challenging the law brought by Ken Paxton, the attorney general of Texas, and 17 other Republican-led states. In December, a federal judge from the Northern District of Texas, Reed O’Connor, ruled that the law was unconstitutional.
The Trump administration is making it a top priority to protect doctors, hospitals or other medical providers who object on a moral or religious basis to providing services like abortion, sterilization or assisted suicide. In a 440-page rule issued Thursday, the HHS Office of Civil Rights said it will use a broader array of tools to enforce more than two dozen “conscience protection” laws, some that have been on the books since the 1970s.
Federal health officials on Monday unveiled a new primary care experiment that seeks to pay doctors for providing stepped-up services that keep patients healthy and out of the hospital, an effort they say will transform basic medical services for tens of millions of American patients. The initiative, called CMS Primary Cares, includes five new payment options for small and large providers, allowing them to take varying levels of financial responsibility for improving care and lowering costs. It broadly seeks to change how primary care is delivered in the U.S. by rewarding doctors for improving management of patients with chronic illnesses such as diabetes and high blood pressure and averting expensive trips to the hospital.
The CMS is inviting state Medicaid agencies to pursue new ways of integrating care for patients eligible for both Medicare and Medicaid—a population that has complex health needs and accounts for a big portion of spending in both public health programs. In a letter to state Medicaid directors, CMS Administrator Seema Verma described three new ways states can test approaches to integrating care for dual-eligible patients with the goal of improving the quality of their care and reducing costs for federal and state governments. “Less than 10% of dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems,” Verma said. “This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all.”
Reports suggest President Trump is planning to release a health care reform plan soon. That’s good news. Republicans may have failed to pass reforms in 2017, but health care nonetheless remains a major concern for Americans. Since the failed reform effort in 2017, conservative health policy experts spent a lot of time working with colleagues across the country to develop a consensus proposal that could succeed where the previous effort fell short. It’s required some hard thinking about the lessons of previous efforts, as well as the failures of implementing Obamacare. This piece highlights seven lessons that will serve policymakers well in crafting the new plan.