With the Affordable Care Act endangered during the first half of 2015, many popular newsroom stories concerned President Obama's signature legislation.
The expanded newsroom of AJMC.com keeps readers coming back each day to find out what’s happening in the world of healthcare. With the fate of the Affordable Care Act (ACA) in the balance for the first half of 2015, it’s no surprise that several of our most-read stories concern President Obama’s signature piece of legislation. Keep returning to AJMC.com in 2016 for the latest updates in payment reform, Medicaid managed care, and other topics in the changing world of healthcare.
Here are the most-read newsroom stories of 2015:
10. Cancer Drugs Driving 340B Growth Even More Than Understood, Report Finds
This story detailed a report commissioned by the Community Oncology Alliance, which has long called for reforming the program that started as a way for safety net hospitals to afford drugs for patients who were uninsured or underinsured. The report examined Medicare Part B hospital payment spending and found that 340B institutions accounted for 58% of all spending on drug payments in 2013, with oncology drugs making up 40% of the Medicare fee-for-service costs. The study, conducted by the Berkeley Research Group, supported earlier findings from the Government Accountability Office (see number 7) and bolstered a guidance from the Health Resources and Services Administration, which seeks to end the practice of using 340B as a profit center. September 15, 2015.
One of the agency’s biggest undertakings in years, this massive rulemaking addressed how states have tried to rein in Medicaid spending in ways that can be harmful for beneficiaries. The rule also addresses the ACA by making it easier for clients to move between Medicaid managed care and offerings on the exchanges as incomes fluctuate, now that Medicaid covers those at much higher income levels. Crackdowns on narrow networks, as well as rating systems and more use of alternate payment models are all reflected here, but many were not happy with this rule. State Medicaid officials in particular cried foul, saying it will dilute their autonomy to craft programs that meet local needs. Some said that “time and distance” mandates overlook innovative delivery methods like telehealth. May 6, 2015.
8. Horizon BCBS Rolled Out OMNIA Prior to Final Regulatory Approval
From our own backyard in New Jersey, AJMC followed the saga of Horizon Blue Cross Blue Shield more closely after speakers at national managed care meetings described the insurer’s decision to create a preferred network that left out many urban hospitals as one of the country’s more egregious examples of narrow networks. For this story, we filed a request under the state’s Open Public Records Act, which produced proof that Horizon had launched its high-profile marketing campaign for the OMNIA plan more than a week before state regulators had actually approved it. That act is part of the basis of a lawsuit from 17 hospitals that is on its way to the New Jersey State Supreme Court, 1 of 3 separate legal challenges still pending. October 19, 2015.
7. GAO Report: Congress Must End Incentives to Prescribe Expensive Cancer Drugs in 340B Program
The GAO’s report landed like a thud in mid-July, affirming the long-held complaints from critics that Congress had to do something about the 340B Drug Pricing Program. The report found that 40% of the nation’s hospitals were now taking part, and the explosive growth was creating inappropriate incentives that would continue if nothing was done. The program was like a carrot causing hospitals to buy more drugs and more expensive drugs, and GAO found both taxpayers generally and patients individually suffer harm, due to the 20% copayments requirements in Medicare. July 17, 2015.
6. Iowa Seeks Formal Bids for Medicaid Managed Care
This was one of several stories on AJMC.com this year that followed Governor Terry Branstad’s controversial attempt to privatize the state’s program for 560,000 Medicaid beneficiaries. Democrats in the Legislature have fought the plan at every step, and in recent days CMS has informed the governor that Iowa not be allowed to flip the switch on January 1, 2016, as planned. While the federal government believes it will ultimately allow Iowa to make the change, the state is not ready and will have to wait until at least March 1, 2016, before turning care management over to 4 contractors. This means Branstad will have to figure out how to make up some of the savings assumed in next year’s budget. February 17, 2015.
5. Next Up Among Haves and Have-Nots Under ACA: Public Hospitals
This story explained a phenomenon that comes when some states expand Medicaid and some do not: big differences in the bottom lines of public hospitals. When patients who have been uninsured all their lives suddenly gain coverage under Medicaid expansion, it changes the fortunes of public hospitals in places like Chicago, where some institutions are running in the black for the first time in decades. But the opposite in true in states where Medicaid expansion is a pariah. In these states, safety net hospitals suffer the worst of all worlds. These facilities must still treat whoever comes through the door, but with fewer resources than ever. The makeup of the ACA assumed these working poor would gain Medicaid coverage through expansion, so to pay for it, the law slowly withdrawals other funding sources. Financially strapped, these hospitals face uncertain futures. July 23, 2015.
4. School Lunch Changes for 2015 May Be Just the Start of Rollback
This story predicted that 2 small changes in the omnibus budget bill of 2014 would be just the start of the food fight of 2015, and we were correct. Giving school districts more time to achieve strict standards on sodium content and whole grain requirements—which would allow the return of popular items like pizza—were smoke signals compared with the showdown that has occurred over the February report from the Dietary Guidelines Advisory Committee. That report not only called for eating less red meat and sugar but also wanted to fold in principles of “sustainability” into food policy. That last part is already on the cutting room floor, and in the most recent budget agreement, Congress inserted language to rein in future dietary panels. The 2015 guidelines aren’t final yet, but most observers agree this has been the most political process ever. January 5, 2015.
Early in the year, a physicians’ group tried once again to challenge the individual mandate, just as King v. Burwell was emerging as a legitimate threat to the ACA. The high court, however, determined that the individual mandate had been settled, and declined to take up the case. January 13, 2015.
The popularity of this story proved a sign of things to come—while the delay of the Cadillac tax was not achieved in this bill, as the story predicted, it was delayed through other means. The so-called “Cadillac tax,” which would have been a 40% excise tax on health plans that cost more than $10,200 for individuals or $27,500 for families. Instead of passing as a freestanding bill loaded with items the President would never sign—such as defunding Planned Parenthood—it was folded into the budget agreement reached last week. For more on the Cadillac tax and why it’s so disliked, read, “5 Things About the Cadillac Tax.” December 3, 2015.
The most-read newsroom item of 2015 is also our saddest: Our current and former editors shared the news that Associate Editor Seema S. Sonnad, PhD, died May 27, 2015, after suffering a cardiac arrhythmia while competing in an ultramarathon. Dr. Sonnad was remembered for her many passions, both academic and athletic, and for her interest in mentoring young scholars, especially women. During 2014, as AJMC planned the events that would culminate in its 20th anniversary celebration, Dr. Sonnad had advocated for creating an award to recognize a young investigator in managed care. In October 2015, The American Journal of Managed Care proudly presented the first Seema S. Sonnad, PhD, Emerging Leader in Managed Care Award to Julia Adler-Milstein, PhD, of the University of Michigan. May 28, 2015.