HealthCare Roundtable e-News – Aug. 25, 2017

CBO Defends Health Care Projections to Congressman

Faced with questions from some congressional Republicans about its forecasts of the impact of GOP health care proposals, the Congressional Budget Office (CBO) has released a letter defending the “objective, impartial, and nonpartisan” nature of its work.

During the failed effort by Republicans to pass health care legislation to repeal and replace the Patient Protection and Affordable Care Act this year, CBO estimated that the various GOP plans that it “scored” would increase the number of Americans without insurance by more than 20 million within a decade. This complicated Republican efforts to win support from both the public and moderate members of their own party, leading to criticisms of the agency from members of Congress and the Trump administration.

In an Aug. 24 letter to Rep. Tom MacArthur, R-N.J., CBO Director Keith Hall reviewed how the agency analyzes legislation. Hall and MacArthur had met on July 12 to discuss the issue in person.

“In addition to those processes and policies, I can report that all of the people at CBO are tasked with maintaining a culture of objectivity impartiality, and nonpartisanship,” Hall wrote. “Employees prize those attributes that bolster the integrity of their analysis, and their interactions continually reinforce the culture.”

MacArthur leads the Tuesday Group, a gathering of moderate House Republicans. He created some dissension within the group when he negotiated with the Freedom Caucus – which includes conservative House GOP members – to tweak the health care bill enough to narrowly get it through the House. The legislation failed to advance in the Senate.

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Democrats Question Administration on Plans for Exchanges

Four senior House Democrats are pressing the Trump administration for details on plans for the 2018 open enrollment period for the health insurance exchanges.

The Patient Protection and Affordable Care Act (ACA), which was passed in 2010, created state-level exchanges – also known as marketplaces – that were launched in 2014 in which people who do not have access to affordable group coverage can buy insurance, in many cases using income-dependent tax credits. States were not required to establish exchanges, but the federal government created one in any state that did not.

In April, the Centers for Medicare & Medicaid Services (CMS) announced that it would implement several measures that the Democrats said in their letter will “undermine” the exchanges. These include cutting the open enrollment period for 2018 in half, so it will run from Nov. 1 to Dec. 15 of this year; requiring individuals who enroll outside of the open enrollment period to submit “supporting documentation” to confirm eligibility; and allowing insurers to require individuals to pay any past due premiums before enrolling in a new plan. In addition, President Donald Trump, who campaigned on a promise to repeal and replace the ACA, has shown little enthusiasm for promoting the exchanges, especially after Republicans in Congress failed to fulfill his promise of ACA repeal this summer.

Democratic Reps. Frank Pallone of New Jersey, Richard Neal of Massachusetts, Patty Murray of Washington and Ron Wyden of Oregon, each of whom is the ranking member on a House committee, wrote to the heads of the Department of Homeland Security and CMS on Aug. 18 to say that they are “deeply troubled” by the administration’s actions regarding the exchanges.

“Rather than encouraging enrollment in the Marketplaces, the Administration appears intent on depressing it, which we fear will contribute to destabilizing insurance markets and drive up costs for consumers,” they wrote.

The lawmakers noted several examples of the administration appearing to pull back efforts to promote enrollment in the exchanges, including closing some call centers, not renewing contracts with companies that helped consumers sign up for coverage, and ending outreach partnerships with organizations that represent Latinos, African Americans and other demographic groups.

“Given the substantial uncertainty resulting from efforts to jam the Republican bill through Congress and the resulting consumer confusion, as well as the Administration’s decision to cut the Open Enrollment period in half, it is critically important that HHS redouble its efforts to ensure that individuals are aware of their enrollment options and eligibility for financial assistance in a timely manner,” they wrote.

The members of Congress asked a series of questions in the letter, including a request for a description of “the Administration’s outreach and enrollment strategy.”

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Doctors to Know Some ACO Patients

Doctors will be able to know who at least some of the patients are in their accountable care organizations, as a result of changes being made by the Centers for Medicare & Medicaid Services (CMS).

Medicare ACOs, which were created by the 2010 Patient Protection and Affordable Care Act, are intended to encourage health care providers to coordinate care for patients in a way that improves quality, cuts costs and moves providers and patients away from the traditional fee-for-service payment model. As long as quality standards are met, ACOs and Medicare share the cost savings that result from coordinating care.

CMS has been notifying doctors of what patients were in their ACOs – and thus what health and cost outcomes they would be judged on – only at the end of each year. Now, though, CMS is asking beneficiaries on the website to provide the name of their primary care physician, Modern Healthcare reported. If that doctor is in an ACO, the patient will be assigned not only to that physician, but also to his or her ACO. About 30 percent of Medicare beneficiaries use the website.

CMS announced in March that it would be making the change, in part, a CMS official said at the time, because “ACOs have told us they prefer to know with more certainty at the beginning of the performance year what beneficiaries the CMS will hold them accountable for.”

Some providers, according to Modern Healthcare, say the change is not sufficient, and all participants in the ACOs should be revealed to them at the beginning of the year.

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FDA Approves 6th Biosimilar

The Food and Drug Administration (FDA) has approved the sixth biosimilar for sale in the United States, and the second one for AbbVie’s Humira.

Biologic drugs are highly advanced medicines derived from biological, rather than chemical, processes. They are among the most innovative of drug treatments and, as such, are also among the most expensive, potentially costing tens, even hundreds, of thousands of dollars each year for a single patient. Generic biopharmaceuticals are expected to offer lower-cost alternatives, as generic versions of traditional drugs do.

The FDA approved Cyltezo (adalimumab-adbm) from Boehringer Ingelheim as a biosimilar to Humira (adalimumab) for the treatment of rheumatoid arthritis, psoriatic arthritic and other conditions.

The first Humira biosimilar to be approved by the FDA was Amjevita (adalimumab-atto) from Amgen, in September 2016.

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