Health Care Delivery

CMS said Thursday that the average 2019 premium charged for the silver level of health insurance in the exchanges set up by the Affordable Care Act (ACA) dropped slightly for the first time since 2014, and Seema Verma, who heads CMS, credited the actions of the Trump administration for the lower premiums.

Senate Democrats were 1 vote short of overturning the Trump administration's expansion of short-term health plans; Celltrion’s CT-P10, a biosimilar to cancer drug Rituxan, received the unanimous support of an FDA advisory panel; Centene will enter 4 new states—North Carolina, Pennsylvania, South Carolina, and Tennessee—and expand offerings in 10 markets in 2019.

Here are the top 5 articles for the month of September.

A survey has revealed gaps in HIV providers’ knowledge of the Affordable Care Act. However, despite these gaps, the majority of surveyed providers expressed belief that Medicaid expansion would improve both HIV outcomes and general outcomes for patients with the disease.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included medical groups asking CMS to halt or slow down its plans to cut physician reimbursement for evaluation and management services; the Senate weighs a package of bills to combat the opioid epidemic; new research shows the Affordable Care Act pushed the uninsured rate down to 10%.

Health insurance coverage gains created by the Affordable Care Act (ACA) caused the number of the uninsured in the United States to fall from 17% in 2013 to 10% in 2016, according to a new analysis from the Urban Institute. The report said the reductions were even more striking in states that expanded Medicaid.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included a study on the impact physician burnout is having on care quality; the latest Affordable Care Act showdown took place in a Texas courtroom; the share of employers offering health coverage increased for the first time since 2008.

A hearing in a federal court in Fort Worth, Texas regarding the Affordable Care Act (ACA) ended Wednesday, with the attorney general for the Lone Star State leading 19 other like-minded Republican states in trying to convince a judge that a preliminary injunction to put the ACA on hold should be granted. Later, Senate Democrats tied the hearing to the Supreme Court nomination hearing for Judge Brett Kavanaugh, who, if confirmed, will likely have to consider the case, Texas v Azar.

The public, including most Republicans, wants protections for people with pre-existing conditions preserved, finds the latest Kaiser Family Foundation health tracking poll. The poll was released as a federal court case regarding the constitutionality of the Affordable Care Act got underway in Texas and as Brett Kavanaugh began his second day of questioning from senators regarding his nomination to the Supreme Court.

Consolidation in California’s healthcare system has had a noticeable impact on measures of vertical integration and premiums for insurance bought through the exchanges established under the Affordable Care Act, according to a study published Tuesday in Health Affairs.

Senate Democrats plan to use the confirmation battle for Brett Kavanaugh's to the Supreme Court of the United States to mobilize their base around threats to the Affordable Care Act (ACA), the social safety net, and reproductive rights; a Texas courtroom will be the setting for another critical chapter in the fate of the ACA; consumers who buy insurance through ACA markets will find premiums have stabilized in 2019.

Over 200 patient and provider groups have written to CMS, saying that proposed consolidation of evaluation and management billing codes will adversely affect the sickest Medicare patients and the physicians that treat them.

GOP senators have introduced legislation they say would protect provisions for preexisting conditions under the Affordable Care Act; Cigna shareholders have voted in favor of the acquisition of pharmacy benefit manager Express Scripts; and study results show that aspirin does not lower cardiovascular (CV) risk in the long-term.

CMS is giving $8.6 million to 30 states and the District of Columbia to help insurance departments stabilize their health insurance markets and implement and plan for consumer protections and market reforms called for under the Affordable Care Act (ACA).

Allowing a partial expansion of Medicaid to some low-income adults may help some people in nonexpansion states, but it would cause a significant loss of health coverage if approved in expansion states, according to a recent analysis by the Center on Budget and Policy Priorities.

Public health advocates are alarmed by a possible shift in long-standing policy about penalizing legal immigrants for accepting healthcare services, food stamps, heating assistance, and other noncash assistance as their applications to become permanent residents are pending.

Following a peak of 17.4 million people enrolled in the individual insurance market in 2015, enrollment has continuously declined. With the elimination of the individual mandate and the expansion of short-term health plans, enrollment will likely continue to drop in 2019.

Major insurers are now seeking smaller, single-digit premium increases for Affordable Care Act (ACA) plans; drug makers and distributors of painkillers being sued for their alleged role in the opioid crisis are trying to build goodwill by giving grants and donations to hard-hit counties, cities, and states that are filing the lawsuits; hundreds of people have sued Bristol-Myers Squibb and Otsuka, alleging that the drug Abilify caused compulsive behavior.

Medicare has lowered its star ratings for staffing levels in 1 out of 11 nursing homes; the Pharmaceutical Research and Manufacturers of America has donated to a lobbying group running a "dark money" campaign in favor of repealing and replacing the Affordable Care Act; a libertarian policy center funded by the conservative Koch brothers found that Senator Bernie Sanders's Medicare for All plan would cost $32.6 trillion over 10 years.

Eleven states and the District of Columbia are suing the Trump administration, alleging it violated the Administrative Procedures Act when it promulgated the rule expanding association health plans.

The FDA is cracking down on a loophold drug companies use to avoid the requirement that they study products in children; a new study finds nearly 6 in 10 Hispanic adults cite a language or cultural barrier that makes it difficult for them to communicate with healthcare providers; a judge has ordered Wisconsin to pay for gender reassignment surgery for 2 Medicaid recipients.

Close to 200 organizations wrote to CMS and HHS this week to express concerns with the Trump administration’s plans to cut millions of dollars from the Affordable Care Act’s marketing and outreach budget, saying that they are “frustrated by CMS’ assertions that the need for these services has decreased as the number of uninsured or underinsured Americans continues to grow.”

Findings from the Foundation for Government Accountability did not net out those who would be eligible for exemptions under CMS rules.