Trump, Harris tread in ACA ambiguity

By Molly Gamble - Is the Affordable Care Act a central issue in the 2024 presidential election or not? With fewer than 90 days until the election, the answer remains unclear as Democratic and Republican campaigns operate with ambiguity when it comes to healthcare plans, and particularly in the use of actions "repeal" and "replace." Read Full Article…

HVBA Article Summary

1. Republican Healthcare Stance: The Republican Party's platform for the upcoming election minimizes discussion on healthcare reform, including no direct mention of the Affordable Care Act (ACA). This is evident from both the official party platform revealed at the Milwaukee convention and former President Donald Trump's Agenda 47, which lacks detailed healthcare policy proposals, focusing instead on broad themes of affordability.

2. Democratic Response and Criticism: In contrast, Vice President Kamala Harris has been vocal about the ACA's importance, criticizing the Republican approach as a threat to healthcare security during her campaign. Her remarks emphasize the potential risks to individuals with pre-existing conditions and the Republican candidate's intent to overturn the ACA, despite counterclaims from the Trump campaign that their goal is to enhance healthcare affordability, not terminate the ACA.

3. Implications and Voter Concerns: Amidst this political back-and-forth, healthcare remains a pivotal issue for American voters, underscored by its ranking as the third-highest priority in recent polls. The ambiguity in Republican healthcare proposals and the potential non-renewal of enhanced ACA subsidies by a Republican administration highlight the ongoing significance and contentious nature of healthcare reform in U.S. electoral politics.

States are writing their own rules for AI in health care

By Maya Goldman - In the absence of federal guardrails on artificial intelligence in health care, state governments are figuring out their own rules of the road. Read Full Article…

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1. Rapid State Legislation Amid Federal Inactivity: Colorado and Utah are at the forefront of state-led AI regulations in healthcare, responding to perceived federal inertia. Colorado's new law mandates ethical AI use, while Utah regulates mental health chatbots and mandates disclosure when AI interacts with consumers. This state-level initiative is driven by the need to manage AI's impact responsibly, as noted by Colorado state Rep. Brianna Titone.

2. Emerging National Patchwork and Concerns: The lack of uniform federal regulations is leading to a fragmented approach across states. This inconsistency poses challenges for health AI implementation and standardization. For example, some states are pushing back against health insurers using AI for care assessments, with potential legislation being stalled by financial concerns in states like California.

3. Prospective Federal Engagement and Industry Dynamics: As the federal government begins to reorganize its health IT framework, the FDA has hinted at forthcoming regulations for AI in drug development, though without a firm timeline. Concurrently, the health care industry, including key players like Google and Microsoft, are working through the Coalition for Health AI to establish standards for transparency, safety, and efficacy of health AI applications.

6 legal and compliance considerations during benefits coverage interruptions

By Eleanor Hecks - Paine College employees were without benefits for two months while the higher education institution hashed out details with their health care benefits provider. The lapse started at the beginning of May and left staff without medical, dental or vision benefits. This situation highlights the need for clear policies on handling a benefits coverage interruption. Read Full Article…

HVBA Article Summary

1. Ensure Regulatory Compliance: It's crucial for businesses, especially those with more than 50 full-time employees, to comply with the Affordable Care Act (ACA) regulations. Non-compliance could result in substantial fines. Smaller businesses should leverage available tax credits to alleviate the financial burden of providing health coverage.

2. Maintain Open Communication with Employees: Immediate and ongoing communication with employees about their health coverage status is vital. Under the ACA, employers must inform employees about available coverage options through the Exchange. Regular updates about any changes or interruptions in coverage and the measures being taken to resolve them are essential to maintaining trust and transparency.

3. Prioritize Data Security and Privacy: In the age of remote work, adhering to data privacy laws such as GDPR or CCPA is mandatory, regardless of the physical location of employees. This becomes even more critical during service interruptions, as maintaining the security of employees' health information is paramount to prevent data breaches, which have been sharply rising.

A proactive approach to long-term care planning can pay off for clients

By Rob Burgess - Long-term health care costs can drain resources in even the most carefully planned retirements. Advisers who work with clients preparing for their post-career lives say starting the conversations early will help mitigate these surprises. But not all remedies are created equal. Some clients may be able to afford long-term care — including home health aides, residential community care and more — out of pocket. Read Full Article…

HVBA Article Summary

1. Starting the Dialogue on Long-Term Care: Financial planning experts like Justin Warren emphasize the importance of early discussions about long-term care as part of retirement planning. This proactive approach helps clients understand and prepare for the potential financial impacts of healthcare needs in their later years. Engaging in these conversations, even if no immediate decisions are made, sets a foundation for informed planning and can alleviate future stress.

2. Exploring Insurance Options and Personal Experiences: Advisors such as David W. Demming and Michael Carbone highlight the value of insurance in managing long-term care costs. They incorporate personal stories and scenario planning to illustrate the financial consequences of health care needs. This personalized approach helps clients visualize the practical benefits of insurance, encouraging them to consider how different types of coverage, such as group long-term disability and life insurance with long-term care riders, can protect their financial wellbeing and legacy.

3. Weighing the Costs and Benefits of Insurance vs. Self-Insurance: Professionals like Tony Matheson and John R. Power work closely with clients to balance the risks and costs of purchasing insurance against self-insuring through retirement savings. This decision-making process often involves analyzing various financial scenarios to determine the most effective strategy for each individual’s situation, taking into account their health, financial resources, and personal preferences regarding risk transfer.

GLP-1 Agonists for Diabetes Tied to Lower Hyperkalemia Rates

By Kristen Monaco - Hyperkalemia in type 2 diabetes occurred less often with GLP-1 receptor agonists in routine care than dipeptidyl peptidase-4 (DPP-4) inhibitors, a large observational study in Sweden showed. Read Full Article…

HVBA Article Summary

1. Risk Reduction for Hyperkalemia: Over an approximate 3.9-month treatment period, GLP-1 receptor agonists were associated with a significantly reduced risk of hyperkalemia compared to DPP-4 inhibitors. The risk of hyperkalemia (potassium levels greater than 5.0 mEq/L) was reduced by 39% (HR 0.61), and for moderate-to-severe hyperkalemia (levels greater than 5.5 mEq/L), the risk reduction was 48% (HR 0.52).

2. Impact on RAS Inhibitor Therapy Continuation: In addition to reducing hyperkalemia rates, GLP-1 agonists were linked with a lower rate of renin-angiotensin system (RAS) inhibitor discontinuation compared to DPP-4 inhibitors. This was seen as a novel finding, with GLP-1 agonist users showing fewer discontinuations of RAS inhibitors (HR 0.89), which suggests potential benefits in sustaining recommended cardioprotective and renoprotective treatments in clinical practice.

3. Study Demographics and Cohort Details: The cohort study examined 33,280 Swedish adults with type 2 diabetes who initiated treatment with either a GLP-1 receptor agonist or a DPP-4 inhibitor between 2008 and 2021. The findings highlighted the pleiotropic effects of GLP-1 receptor agonists on potassium homeostasis, possibly through mechanisms involving increased urinary potassium excretion, and provided evidence suggesting these agents could improve clinical outcomes by allowing continued use of essential medications.

States may seek tougher enforcement of health plan transparency disclosures

By Allison Bell - State insurance regulators are thinking about whether they should push health plans to post what they pay for care in an easier-to-use format. Read Full Article…

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1. Challenges in Accessing and Using Transparency in Coverage Data: Despite the implementation of federal Transparency in Coverage (TiC) rules in July 2022, which mandate insurers and self-funded employer health plans to disclose in-network and out-of-network payment rates, Sabrina Corlette of Georgetown University's Center on Health Insurance Reforms highlights significant accessibility and usability issues. The TiC data, intended to foster pricing transparency, remains hard to locate and interpret for the general public.

2. Proposed Enhancements to TiC Rules: Corlette is set to brief the Health Insurance Committee of the National Association of Insurance Commissioners on improving TiC regulations to facilitate patient decision-making in healthcare and control costs. Her suggestions include standardizing TiC data summaries, adopting uniform formats, creating accessible data directories, and enforcing stringent data quality standards.

3. Broader Implications for Healthcare Management: Improving the TiC framework could not only help patients make informed choices but also provide employers and brokers with crucial data to better design and manage health plans. This enhancement is expected to increase transparency, leading to more competitive healthcare pricing and potentially lower healthcare costs overall. Corlette's briefing aims to garner support from various stakeholders, including state regulators and federal agencies like the U.S. Labor Department and the Centers for Medicare and Medicaid Services.

Pharma execs react to final drug price negotiations with Medicare

By Amy Baxter - While the Centers for Medicare and Medicaid Services is expected to publish the new Medicare prices of the first 10 drugs selected for the initial wave of negotiations on Sept. 1, pharma companies already know how the policy will impact their portfolios. Read Full Article…

HVBA Article Summary

1. Negotiations Under the Inflation Reduction Act: The Inflation Reduction Act's drug price negotiations concluded on August 1, but the new pricing will not take effect until 2026. Pharmaceutical companies, particularly Johnson & Johnson, face significant exposure due to these negotiations, which targeted 10 high-expenditure drugs under Medicare Part D, covering treatments for cardiovascular diseases, diabetes, and cancer. Despite pharma leaders downplaying the impact during earnings calls, legal challenges against the price negotiation provisions have persisted.

2. Pharmaceutical Companies' Responses and Financial Impact: Key pharma companies like Bristol Myers Squibb, Pfizer, and Eli Lilly reported substantial revenues from their leading drugs, such as Eliquis and Jardiance, expressing varying levels of concern about the future impact of the Act on their portfolios and innovation in the pharmaceutical industry. While some, like BMS, expressed confidence in managing the impact, others, including Novartis and Amgen, criticized the government's approach to price setting as detrimental to long-term innovation and patient care.

3. Future Outlook and Legal Challenges: The pharmaceutical industry is bracing for further impacts from additional rounds of drug selections by CMS, with concerns about the long-term implications for innovation and new drug development. Legal battles continue as companies like Merck and AstraZeneca have taken legal actions against the Department of Health and Human Services, challenging the constitutionality of the drug price negotiation provision. Meanwhile, companies are strategically shifting focus, as seen with AstraZeneca's increased investment in biologics over small molecules due to the Act's earlier negotiation timeline for small molecule drugs.

Gen X and millennials would pay higher taxes to access Medicare

By Deanna Cuadra - Have Americans made peace with the fact that they will likely not have access to Medicare when they turn 65? It doesn't look like it. Read Full Article…

HVBA Article Summary

1. Entitlement and Willingness to Invest: According to a survey by eHealth involving 1,000 Americans born between 1965 and 1996, there is a strong sense of entitlement towards Medicare among millennials and Gen Xers, with 94% feeling they deserve Medicare benefits in retirement. Furthermore, 84% expressed willingness to pay higher taxes to ensure Medicare's longevity. This sentiment underscores the value placed on Medicare, even as concerns about its financial sustainability loom, with projections suggesting that Medicare funds may deplete by 2036 unless legislative actions are taken.

2. Potential Impacts of Funding Shortfalls: The potential depletion of Medicare funds could significantly alter the landscape of retirement healthcare. Whitney Stidom, the Vice President of Medicare Operations at eHealth, highlighted that while Medicare Part A (inpatient care) might only cover 89% of services by 2036, Parts B and D (covering outpatient services and prescriptions) would remain largely intact. Despite this, retirees could face increased out-of-pocket costs, higher deductibles, and reduced coverage for preventative care, impacting their financial planning for healthcare in retirement.

3. Importance of Medicare in Voter Priorities and Employer Strategies: Nearly 80% of the millennials and Gen Xers surveyed ranked Medicare among their top three voting priorities, indicating a potential pressure point for congressional action. Stidom emphasizes the importance of employers enhancing retirement and financial planning benefits in light of the challenges posed by rising healthcare costs. He advocates for a dual approach of financial aid and educational resources to help employees leverage tools like health savings accounts effectively, which can be invested and used tax-free post-65, further emphasizing the need for informed planning and proactive investment in healthcare security.

Appeals court hands providers latest win in No Surprises litigation

By Rebecca Pifer - A provider group has prevailed in the latest in a string of lawsuits against the federal government over how regulators interpreted the No Surprises Act in creating a dispute resolution process for insurers and providers at odds over out-of-network medical bills. Read Full Article…

HVBA Article Summary

1. Court Decision and Legal Arguments: In February 2023, a district court ruled in favor of the Texas Medical Association (TMA), vacating specific instructions that arbiters must prioritize the insurer-set qualifying payment amount (QPA) when deciding on provider payment disputes under the No Surprises Act. The court found this directive unfairly favored insurers, prompting an appeal by the Biden administration. On Friday, the 5th Circuit Court of Appeals upheld the lower court's decision, reinforcing that arbiters should have the discretion to consider multiple factors, not just the QPA.

2. Implications for the No Surprises Act Implementation: The court rulings have significant implications for how the No Surprises Act, designed to protect consumers from unexpected medical bills, is implemented. The law requires a fair arbitration process between insurers and providers if they cannot agree independently. The controversy centers on the government’s interpretation that arbiters should first consider the QPA, which providers argue is an inadequate measure often set too low by insurers.

3. Ongoing Legal Battles and Systemic Impact: This lawsuit is one of several initiated by the TMA, challenging the federal government's implementation of the No Surprises Act. The ongoing legal disputes have caused repeated pauses and restarts in the dispute resolution process, contributing to a backlog and increasing the strain on the system. As courts consistently side with the TMA, these cases are shaping the operational landscape of the IDR process and influencing the broader conversation about fair medical billing practices.