HealthCare Roundtable e-News – July 8, 2024

 

Top News

Supreme Court Rules Against Regulators, Expands Grounds for Challenging Regulations 

The U.S. Supreme Court ruled against regulators in a decision that will strengthen industries’ challenges of federal agencies and their regulations. The ruling, involving a lawsuit in which a North Dakota truck stop challenged a 2011 Federal Reserve rule that capped “interchange fees” at 21 cents per transaction plus a small percentage of that transaction’s value, rejects the Justice Department’s argument that the statute of limitations runs from when a regulation is finalized. Now, old agency rules may be challenged so long as they produce present harm. Justice Amy Coney Barrett wrote the opinion for the 6-3 majority, with the liberal justices representing the dissenting opinion. This decision, combined with the Court’s recent overturning of Chevron v. Natural Resources Defense Council, has opened the door to new, broad challenges to regulations long after they take effect. In the past, statutes of limitation and other prohibitions prevented litigation of regulatory decisions made many years in the past. Now, it is reasonable to expect significant increase in judicial activism on many previous regulatory decisions.

 

CMS Announces Information Collection Request for 2027 Drug Price Negotiation Data Elements and Drug Price Negotiation Process

The Centers for Medicare and Medicaid Services (CMS) announced an information collection request on Negotiation Data Elements and Drug Price Negotiation Process for Initial Price Applicability Year 2027 of the Medicare Drug Price Negotiation Program. The Negotiation Data Elements includes the data CMS would consider as the basis for determining offers and counteroffers throughout the negotiation process based on the submissions required from a participating drug company. The Drug Price Negotiation Process includes the data and information CMS would consider if a participating drug company submits a counteroffer for a selected drug during the negotiation process. CMS invites feedback on their burden estimates, the necessity and utility of the information collection, accuracy of the estimated burden, ways to improve the quality and clarity of the information, and the use of technology to minimize the burden. Comments are due by September 3, 2024.

 

ASPE Releases Fact Sheet on Impacts of IRA and ACA on Healthcare Costs by State

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) released fact sheets highlighting healthcare cost savings due to the Inflation Reduction Act (IRA) and Affordable Care Act (ACA). The fact sheets include information on enrollee savings from cost-sharing on Medicare Part D, insulin, and vaccines, Marketplace premiums, and enrollment data for Medicare, Medicaid, and Marketplace plans. Fact sheets are divided by state and include all 50 states and the District of Columbia.

 

KFF Publishes Brief on Financial Performances of Health Insurers in 2023

The Kaiser Family Foundation (KFF) recently published a brief on private health insurance companies’ financial performance in 2023 across various markets, including Medicare Advantage, Medicaid managed care, individual, and group health insurance, with each market having distinct rules affecting their gross margins and medical loss ratios (MLRs). Private insurers increasingly participate in public programs, with over half of Medicare beneficiaries and nearly three-quarters of Medicaid enrollees in private plans. In 2023, Medicare Advantage had the highest per enrollee gross margins, while individual insurance had the lowest MLRs. Despite stable gross margins across markets, administrative costs and taxes likely impacted profitability. Market trends reveal stability in gross margins and MLRs, though specific factors like the end of continuous enrollment policies in Medicaid and the rise of consolidation affect performance metrics. Medicare Advantage plans show higher costs and premiums due to an older, sicker population, resulting in higher gross margins.


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