New Congress brings churn in health policy leadership

By Sandhya Raman - Congress’ most influential health panels will see dramatic changes next year, with several advocates on specific issues like mental health, Medicare and drug pricing retiring or losing their reelection bids. Read Full Article…

HVBA Article Summary

1. Significant Leadership Turnover in Health-Related Committees
   Key committees, including the House Energy and Commerce Committee and Senate Finance Committee, face substantial membership changes. Notable exits include Anna G. Eshoo, a champion for Medicare drug pricing and biomedical research, and Cathy McMorris Rodgers, a leader in CDC oversight. The Health Subcommittee will also lose five Democrats and four Republicans, including advocates for the 988 suicide hotline and organ transplant legislation. These changes could disrupt momentum on ongoing health policy initiatives.

2. Policy Continuity Uncertain Amid Member Departures
   The departure of influential lawmakers raises questions about leadership on key issues such as drug pricing reform, disability rights, and mental health initiatives. The Bipartisan Mental Health and Substance Use Disorder Task Force and the Congressional Cannabis Caucus will lose pivotal figures, including Rep. Ann McLane Kuster and Rep. Earl Blumenauer. Their replacements may struggle to maintain the same level of advocacy and expertise, particularly in areas like cannabis legalization and behavioral health clinics.

3. New Opportunities for Fresh Leadership and Direction
   Incoming members, including Republican doctors Bob Onder and Mike Kennedy, may introduce fresh perspectives on health policy. With committee chairs like Michael D. Crapo likely taking on leadership roles, priorities such as renewing Trump-era tax laws and addressing Medicaid funding could dominate. However, the path forward remains uncertain as the balance of party representation and the outcome of remaining elections will shape committee dynamics.

Payer executives expect limited change in ACA subsidies

By Rylee Wilson - Payer executives expressed confidence in the continuation of enhanced subsidies in some form past 2025. Enhanced subsidies, which help individuals with incomes up to 400% above the federal poverty line afford coverage, will expire at the end of 2025 without Congressional action. Read Full Article… 

HVBA Article Summary

1. Record ACA Enrollment Driven by Subsidies: Enhanced subsidies have led to historic ACA enrollment levels, contributing to the lowest uninsured rate in the U.S. (below 8%), according to Oscar Health CEO Mark Bertolini. He cautioned that removing these subsidies could reverse progress, exacerbating inflationary pressures and healthcare access challenges.

2. Political Uncertainty and Bipartisan Incentives: With Republicans projected to control the presidency and Congress in 2025, there is a possibility of the subsidies expiring. However, payer executives, including Centene CEO Sarah London, emphasized the bipartisan appeal of the ACA marketplace, highlighting its role in expanding affordable healthcare and its strong support across party lines.

3. Payers Committed to ACA Marketplace: Despite potential changes to subsidies, major insurers, such as Elevance Health and Oscar Health, expressed their commitment to the ACA marketplace as a strategic area for growth. These executives noted the program’s durability and its alignment with long-term business goals, even in a shifting political landscape.

J&J Sues Its Regulator Over the 340B Drug Program

By William Sarraille - Johnson&Johnson, a major pharmaceutical maker, has sued the Health Services and Resources Administration, the federal agency that administers the 340B drug discount program. Read Full Article…

HVBA Article Summary

1. The Conflict: J&J is suing HRSA over its refusal to allow a rebate model for the 340B program, which J&J claims is necessary to verify purchases amid explosive program growth. HRSA, under pressure from covered entities, opposes the model and has threatened to block Medicare and Medicaid coverage for J&J’s products, a stance J&J says contradicts the 340B statute.

2. Broader Implications: The lawsuit’s outcome could reshape the 340B program and affect Medicare’s negotiated drug prices starting in 2026. J&J argues a rebate model is essential for timely payments under the Inflation Reduction Act, exposing flaws in the 340B program, including its limited focus on aiding vulnerable patients.

3. Critiques and Concerns: J&J criticizes HRSA and covered entities for misusing the 340B program, benefiting for-profit players and affluent hospitals over needy patients. The complaint also highlights potential weaknesses, such as concessions about HRSA’s authority, raising questions about broader reform strategies.

FDA struggles to retain inspectors: GAO

By Alexandra Murphy - The FDA continues to face significant staffing shortages in its drug inspection workforce, according to a new report from the Government Accountability Office. Read Full Article… 

HVBA Article Summary

1. Inspection Shortfall: Despite efforts to resume in-person inspections post-COVID-19, the FDA's oversight remains strained, with fiscal 2023 inspection numbers still 36% lower than pre-pandemic levels due to investigator shortages and high workforce attrition.

2. Workforce Challenges: Persistent investigator turnover and reduced capacity have hindered the FDA's ability to meet its inspection goals, with agency officials acknowledging that the lack of experienced inspectors is a significant barrier.

3. GAO Recommendations: The GAO urged the FDA to collaborate with stakeholders to develop comprehensive strategies addressing the root causes of workforce attrition, but ongoing vacancies and turnover threaten to delay progress in restoring full inspection capabilities.

Medicare Premiums Growing Twice as Fast as Social Security COLA

By Brian Anderson - Medicare Part B premiums and deductibles are going up again for 2025, and a new analysis has found that the premiums are growing at more than double the rate of the annual Social Security cost-of-living adjustment (COLA) in recent years. Read Full Article…

HVBA Article Summary

1. 2025 Medicare Premiums and Deductibles Increase: The Centers for Medicare and Medicaid Services (CMS) announced adjustments for 2025 Medicare costs. The Medicare Part B standard monthly premium will rise to $185, up $10.30 from 2024, and the annual deductible will increase to $257, up $17. Part A inpatient hospital deductible will rise to $1,676, while daily coinsurance amounts for hospital stays and skilled nursing facilities will also see modest increases.

2. Impacts on Social Security and High-Income Beneficiaries: Social Security beneficiaries will feel the financial impact as Part B premiums grow at 5.9%, outpacing the 2.5% COLA increase. High-income earners face steeper costs, with monthly premiums potentially reaching $628.90 for certain individuals. Additionally, about 8% of Medicare beneficiaries will pay income-related monthly adjustment amounts (IRMAA), further increasing their costs.

3. Health Savings Accounts (HSA) and Flexible Spending Arrangements (FSA) Updates: The IRS has raised 2025 contribution limits for HSAs to $4,300 for individuals and $8,550 for families, while FSAs will allow contributions up to $3,300, with a $660 maximum carryover. These adjustments reflect broader efforts to adapt tax-advantaged accounts to rising healthcare costs, offering participants more flexibility to manage out-of-pocket medical expenses.

Will Republicans try to change the federal group health tax rules?

By Allison Bell - House Republicans could propose a cap on the tax exclusion for employer-sponsored health benefits in 2025. Tracy Watts and Geoff Manville, health policy experts at Mercer, discuss that possibility in a look at how the results of the Nov. 5 elections could affect health benefits policy. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Expiration of Tax Breaks and Potential Changes: With the Tax Cuts and Jobs Act of 2017 tax breaks set to expire at the end of 2025, discussions have emerged about revising the tax exclusion on employer-sponsored health benefits. Conservative think tanks and House Republicans are exploring the idea of capping the exclusion as a way to offset the cost of extending other tax cuts.

2. Potential Impact on Employers and Workers: Capping the group health tax exclusion could significantly affect employers and employees, as the exclusion currently shields $345 billion annually in tax revenue. Employer groups emphasize that for every $1 in tax savings from the exclusion, businesses invest an additional $5.36 in health benefits, highlighting the exclusion's role in funding robust employee benefits.

3. Legislative Advocacy and Stakeholder Engagement: Analysts and employer advocacy groups, such as Mercer, are actively educating lawmakers on the consequences of capping the tax exclusion. Past legislative efforts, such as the "Cadillac plan" excise tax repealed in 2019, illustrate the challenges and bipartisan resistance to limiting health benefit-related tax advantages.

Surgeons Billed $2 Billion for Unnecessary Spine Surgeries: Report

By Cheryl Clark - More than 200,000 Medicare patients with back pain underwent $2 billion worth of unnecessary surgeries, including spinal fusion and/or laminectomy or vertebroplasty, over a recent 3-year period, according to an analysis of Medicare claims data from the Lown Institute. Read Full Article… 

HVBA Article Summary

1. Risks and Limited Effectiveness of Spinal Surgeries
   Unnecessary spinal surgeries like fusion and laminectomy pose risks such as infections, blood clots, and death. These procedures are only effective for specific conditions like nerve compression, while general back pain from aging often benefits more from non-surgical treatments, according to the Lown Institute report.

2. Medicare Policies and Financial Incentives
   Medicare pays for surgeries without requiring diagnostic justification, enabling overuse. The spine surgery industry, with companies like NuVasive and Medtronic paying surgeons millions, drives these procedures, further incentivized by costly spinal hardware.

3. Hospital and State Disparities
   Rates of unnecessary procedures vary widely, with Mount Nittany Medical Center at 62.8% and Avala Hospital at 0.1%. States like New Hampshire and Pennsylvania had the highest rates, highlighting a lack of standardized practices and oversight.