This Week in Healthcare Reform: October 30th, 2020

A look at how the coronavirus health crisis has impacted our approach to health care delivery; private equity-backed air ambulances are found to charge the highest rates; Big Pharma sticks to its business-as-usual approach to price hikes despite the ongoing health crisis; and, Medicare Advantage plans adapt to a COVID operating environment.

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Week in Review

COVID Impacts: It’s no overreaction to appraise our health care delivery model through two sets of very different lenses – specifically, one from before COVID-19 and one that continues to operationalize the changes exacted on that system by the ongoing public health crisis.  Already, stakeholders have found themselves having to adapt in real-time to meet the needs of their constituents – from providers to employers to insurers.  From a practical standpoint, our transition to a system that focuses on value has also undergone something of a realignment, as the pandemic has forced a comprehensive reevaluation of what may be deemed as high-value versus low-value care.  Policymakers have also had to turn their attention to taking legislative and regulatory actions aimed at mitigating the fallout from the pandemic.  In fact, it’s safe to say that the coronavirus has accelerated something of a reassessment in regards to health care reform, writ large.

Air Ambulance Costs: According to a recent study, high air ambulance charges are most often leveled at patients from private equity-backed carriers.  In fact, just two of these firms charged more than $48,000 on average for transport (7.2 times the Medicare rate), compared to the nearly $29,000 (which is still high at 4.3 times Medicare) charged by non-private equity-owned companies.  Further, the astronomical charges from these two private equity companies have grown at a faster rate than those other air ambulance interests, a fact which becomes all the more distressing with nearly two-thirds of the national Medicare market being under control of these firms as of 2017.  And, while we already knew that these charges are frequent sources of surprise medical bills, we’re only now starting to get a clearer picture of how we all end up paying to cover these outrageous fees through higher premiums. 

Rx Price Hikes: You’d be excused if you thought that Big Pharma would join their health care industry stakeholder peers in meeting the moment by placing the immediate health concerns of Americans above their own profit-generating motivations in the wake of the coronavirus.  Unfortunately, as they’ve shown time and again, drugmakers are seemingly unable to resist the temptation to charge as much as they’re able to get away with, as it didn’t take long for their true colors to surface.  Pretty early on, pharmaceutical manufacturers hiked prices on hundreds of drugs, including those commonly used in intensive care units, lifesaving cancer drugs, and even on medications being used to combat and treat COVID-19.  In fact, it’s this last category that’s especially hard to swallow, given that the hefty price tag (more than $3,100 per course of treatment) for one of those drugs – Remdesivir – completely ignores the taxpayer investment (made through the NIH, with estimates as high as $6.5 billion) in its creation.

Coronavirus Reshapes MA: The popular Medicare Advantage (MA) program had already shown itself to be a valuable (and popular) option for beneficiaries well before the coronavirus health crisis hit.  On this side of the pandemic, MA has continued to provide enrollees with access to the critical resources they need to better manage the disruptions caused by the pandemic.  Almost immediately, MA plans’ embrace of telehealth kept patients meaningfully connected to their health care providers.  Additionally, these plans, recognizing the impact of COVID-19 on social risk factors, targeted their populations with programs focused on food insecurity and isolation.  In fact, a new analysis found that one-third of all MA plans will offer supplemental benefits tied to the pandemic next year, something worth keeping in mind with Open Enrollment in Medicare having begun earlier this month and running through early December.


With Election Day upon us, stakeholders take a final look at how the results will impact health care policy at the federal and state level, both, now and down the road.

Stay safe and be well.

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