This Week in Healthcare Reform: November 20th, 2020

States scramble as coronavirus cases surge; the harmful rebate rule resurfaces; Medicaid shines a light on social health factors; and, a quick check-in on open enrollment.

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Week in Review

COVID States: With diagnosed cases of coronavirus spiking across the country, states find themselves scrambling in an attempt to contain the spread ahead of the Thanksgiving holiday.  Already, governors from the coasts to the heartland have taken action aimed at restricting large gatherings and encouraging the use of face coverings.  This past Sunday, the US eclipsed 11 million cases of coronavirus, just six days after having hit 10 million cases.  Even more distressing, the record-breaking number of patients now hospitalized, exacerbating the strain on our already-overburdened health system.  Further driving the urgency is the worry that, as we head into the colder weather months, more Americans will be forced indoors, where COVID is more easily spread.  Despite the pressing urgency of the pandemic, the policy responses from states continue to vary, prompting alarm from public health experts.

Rebate Rule: The expensive and unpopular “rebate rule” resurfaced earlier this week, as the Administration took a step towards enacting the policy on Monday.  The rebate rule has had a checkered history, having been initially floated last year, before being pulled when analysts determined that the proposal would only serve to raise premiums for seniors in Medicare Part D and further burden taxpayers, while doing nothing to actually address rising prescription drug costs.  As a reminder, the rule seeks to end the current drug rebate program, which sees pharmacy benefit managers (PBMs) pass on those manufacturer rebates to health plans, who then use those savings to lower premiums for consumers.  Studies have shown this to be the case, with PBMs passing more than 99 percent of the rebates they negotiate from drug manufacturers to Part D plans.  In fact, eliminating the rebates would increase federal spending by nearly $200 billion over the next ten years.

Medicaid & SDoH: Our understanding of how non-medical social factors impact overall health and wellness has grown exponentially.  To better address whole-person health, our system has evolved to integrate and operationalize social determinants of health (SDoH) into how it both diagnoses and treats patients.  Unsurprisingly, the coronavirus health crisis has also brought increased focus on the role that SDoH plays in the health outcomes of already-vulnerable populations.  Given how so many of these factors (e.g., housing, food security, transportation, economic opportunity) intersect with the Medicaid population, experts and stakeholders point to the program as being an invaluable resource in refining and improving our approach to the issue.  A new study explores exactly that interplay, shining a spotlight on how Medicaid programs have responded to these circumstances with innovative solutions.  The overarching takeaway of the report is that these programs, broadly, have pursued SDoH as a key aim in looking to better meet the health needs of Medicaid beneficiaries.  In fact, what researchers found was that the extent of this approach had become commonplace, the consensus being that addressing SDoH was critical to the health and well-being of this vulnerable population – a trend that they only expect to accelerate.

Open Enrollment: Despite the uncertainty surrounding the future of the law, Americans continue to sign up for coverage on the Affordable Care Act’s health insurance exchange marketplaces.  Against the backdrop of both the coronavirus pandemic and the legal challenge to the law’s constitutionality before the Supreme Court, the marketplaces were stable heading into this year’s open enrollment period.  With this in mind, supporters have come together to promote open enrollment, encouraging Americans to sign up before the window closes on 15 December.


A new infographic breaks down how our health care dollars are spent.  While at first blush prescription drugs seem to account for the greatest share of that spending, when taken together, spending on providers (i.e., in-patient and out-patient hospital costs, ER costs, and doctor visits) actually make up the lion’s share of our overall spend.

With Thanksgiving upon us, there won’t be a newsletter next week.  But, look for us again in your inbox the following Friday.

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Have a safe and wonderful Thanksgiving!