Last Week in Healthcare Reform: February 7th, 2022

House lawmakers signal their support for Medicare Advantage ahead of proposed changes being released; stakeholders respond to legal challenges to new surprise medical billing consumer protections; meanwhile, emergency room costs continue to overwhelm patients; and, a new report details how rising drug prices are impacting millions of Medicare enrollees.

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Item of the Week

Week in Review

MA Support: With annual proposed changes to the underlying funding and administrative structure for Medicare Advantage (MA) now having been released, stakeholders have been hard at work reminding decision-makers just how popular – and effective – the program is. And, it appears that lawmakers have been listening, as late last month more than 340 lawmakers in the U.S. House of Representatives signed onto a letter of support sent to the Centers for Medicare & Medicaid Services (CMS), urging the agency to protect the program and its ability to provide millions of beneficiaries with access to affordable, high-quality healthcare. In the letter, lawmakers highlighted the important role that MA plays in the lives of over 27 million enrollees – more than 43 percent of all Medicare-eligible beneficiaries. With average monthly premiums in the program on track to reach an all-time low, the letter goes on to urge CMS to maintain “a stable rate and policy environment” and to express gratitude to the agency for its continued support of MA. 

Surprise Medical Billing: New consumer protections against surprise medical bills that went into effect at the beginning of the year continue to be threatened by opponents who have filed legal challenges seeking to unravel the law. In fact, these lawsuits have left many healthcare experts wondering what’s really driving this opposition, given that they’re largely being brought by the nation’s largest hospital and provider lobbying groups rather than the private equity interests that have played an outsized role in making surprise medical billing a revenue-generating business model. That notwithstanding, stakeholders – including Congressional leaders, health policy experts, patient and disease groups, and business and employer organizations – have all rallied to challenge those legal threats, filing briefs of their own in support of the new law.

ER Costs: Emergency room (ER) utilization continues to be a growing area of concern in our evolving healthcare cost conversation. And, with recent estimates pegging ER costs at more than $76 billion annually, it’s no surprise, especially as new data only shows those costs going up. Compounding the issue are reports of ER firms overbilling for services – which, for one patient, would be an improvement, having made headlines last month after receiving a bill for over $1000 from the ER for a visit in which the doctor never even showed up.

Rx Report: As featured in last week’s Health Action Network newsletter, a new report seeks to draw attention to the impact that rising drug prices continue to have on Medicare enrollees. According to the data released by the Office of Health Policy at the Department of Health & Human Services (HHS), 3.5 million Americans aged 65 and older struggled to afford their prescription medicines in 2019. The HHS report, based on data from the annual National Health Interview Study, goes on to show that an additional 1.8 million Medicare beneficiaries under the age of 65 also had problems affording their medications. The report goes on to warn that “the high cost and out-of-pocket expenses of drugs cause many Americans – particularly those with chronic conditions such as diabetes – to delay or skip needed treatments.”


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