This Week in Healthcare Reform: November 13th, 2020

Supreme Court arguments are made in the latest challenge to the Affordable Care Act; proposed changes to the popular Medicare Advantage program are released; telehealth continues to assert itself; and, stakeholders focus on improving population health.

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Week in Review

ACA’s (Latest) Day in Court: On Tuesday, arguments were heard in the latest case to make its way to the Supreme Court challenging the Affordable Care Act (ACA).  At issue, whether or not the law is unconstitutional, given that Congress zeroed out the individual mandate penalty.  Having done so, ACA opponents argue, the law no longer raises revenue.  Without that tax penalty, their argument continues, the law no longer contains the basis for the Supreme Court’s 2012 ruling affirming the ACA’s constitutionality.  They go on to assert that, as the mandate is so interwoven with the rest of the ACA, the law must now be struck down in its entirety.  This marks the third time the Supreme Court has heard a significant challenge to the ACA.  In hearing the questions posed by the Justices, experts believe the Court has signaled an unwillingness to tear down the law.  A decision isn’t expected until the end of the current term next June.

MA Proposed Changes: Late last month, the Centers for Medicare & Medicaid Services (CMS) released its annual proposed changes to the Medicare Advantage (MA) and Prescription Drug Part D programs.  Those changes were announced three months earlier than normal to allow plans more time to prepare against the backdrop of the ongoing COVID-19 pandemic.  While CMS expects payments to MA and Part D plans to grow by nearly 3 percent, the agency also projected costs to go up more than 4.5 percent in 2022.  Other methodological payment proposals temper the reaction to the positive projected growth in payments, with analysts cautioning that these underlying administrative changes could have a downward effect on plan rates, which, in turn, could negatively impact MA and enrollees’ access to the program’s popular range of benefits.

Value of Telehealth: A new survey shows that patient satisfaction with telehealth is high in the wake of the coronavirus health crisis.  Performed by J.D. Power, the overall patient satisfaction scores across all telehealth providers came in at 860 on a 1,000-point scale – one of the highest such scores ever recorded by the firm in a health care services study.  It’s not all rosy, though, as about half of all patients still cited some barriers to accessing virtual care.  Nevertheless, experts believe telehealth should be expanded, especially if it’s able to help address some of today’s health care challenges.  One way or another, there’s a growing sense that telehealth is poised to radically reshape our health care delivery model – but, only if we do well to operationalize the lessons learned since COVID forced our rapid embrace of digital health technologies. 

Population Health Focus: If the coronavirus has taught us nothing else, it’s that responding to public health emergencies requires a sophisticated and integrated coordination of efforts, involving stakeholders from across the health care spectrum.  These lessons-learned have also found resonance in our approach to population health, where there’s growing recognition that better addressing the diverse health needs of equally diverse communities requires a focus on social determinants of health.  This approach has evolved to include hospitals, insurers, and other health systems and community organizations to target, not just the physical and mental components of health, but the underlying social factors that make up an individual’s whole-person well-being, including housing, food security, transportation, and economic opportunity.


Legal challenges to the election results notwithstanding, experts have begun to take a look at what a Biden Administration means for health care, with the possibility of a divided Congress looming.

Stay safe and be well.

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