Health Care Delivery

The Trump administration is planning an Affordable Care Act replacement plan; a drug-resistant fungus has been spreading and causing severe issues for hospitals; protesters gather in Washington, DC, to criticize the FDA's handling of the opioid crisis.

Medicare Advantage (MA) plans will see a 2.53% increase in payments in 2020; the FDA is developing a framework for regulatory oversight of artificial intelligence (AI); a federal court is allowing Wisconsin to withdraw 2 lawsuits from the state challenging the Affordable Care Act (ACA).

The American Medical Association and the AARP issue briefs in defense of the Affordable Care Act (ACA), while President Trump is delaying an ACA alternative until after the 2020; top hospitals offer unproven stem cell treatments; the measles outbreak hits a new high.

A study found that out of hundreds of specialty drugs, only 16% were covered in the same way by 17 commercial payers in the United States, meaning that 84% of those specialty drugs had differing coverage, explained James D. Chambers, PhD, MPharm, MSc, associate professor, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.

Another federal district court judge has handed the Trump administration a major defeat this week in its attempts to redo rules about US health insurance, saying that its efforts to expand association health plans (AHPs) were “clearly an end-run” around the Affordable Care Act (ACA).

A US District Court judge in Washington, DC, agreed with plaintiffs who argued that the HHS Secretary did not act reasonably in allowing states to create work requirements for beneficiaries to receive healthcare. Orders sending both state waivers back to HHS are expected today.

HHS Secretary Alex Azar and Attorney General Bill Barr opposed the Trump administration’s support to overturn the Affordable Care Act (ACA) through a federal lawsuit; OxyContin maker Purdue Pharma and its owners, the Sackler family, agreed to pay $270 million to avoid a state court trial in Oklahoma over the company’s role in the spread of opioids over the past 20 years; a New York county is banning unvaccinated children in public places in the wake of a measles crisis that has infected more than 150 people.

A report from the Urban Institute examined changes in Affordable Care Act (ACA) marketplace rating regions from 2017 to 2019.

The March issue of The American Journal of Managed Care® (AJMC®) featured research on immuno-oncology costs and Medicare Annual Wellness Visits in addition to studies on the issue’s theme of Medicaid. Here are 5 findings from research published in the issue.

“Medicare for Al” refers to a bill originally introduced to Congress in September 2017 by Senator Bernie Sanders, I-Vermont, with 16 Democratic cosponsors that would create a single, federal, government-administered program to provide healthcare to all US residents. In February 2019, Representative Pramila Jayapal, D-Washington, introduced the Medicare for All Act of 2019, with 106 cosponsors. This bill builds upon the legislation that Sanders introduced, with a few key differences. Here are 5 things to know about the bills.

An analysis of exchange premiums finds that older adults with incomes just above the premium subsidy cutoff (400% of poverty), particularly in rural areas where premiums are highest, have the most severe affordability challenges.

Drug use is fueling record-high syphilis rates around the nation, a CDC report said; the Fifth Circuit Court of Appeals is allowing House Democrats to defend the Affordable Care Act (ACA) in a lawsuit that challenges the law’s constitutionality; the World Health Organization (WHO) is convening an expert meeting in March to develop global standards for the governance and oversight of human gene editing.

A new report from the Commonwealth Fund looking at healthcare coverage said the uninsured rate is basically unchanged from before President Trump took office, but that more people, primarily those who have coverage through work, are underinsured. By late fall of 2018, 12.4% of adults were uninsured, down from a high of 20% before the Affordable Care Act became law.

A study presented at the AcademyHealth 2019 National Health Policy Conference, held February 4-5 in Washington, DC, found that the adoption of Medicaid expansion under the Affordable Care Act has been linked to lower rates of maternal mortality.

Consumers shopping for insurance online last fall were most often directed to websites that promote individual health plans that didn’t meet consumer protections of the Affordable Care Act (ACA).

Voters in the red states of Utah and Idaho voted to expand Medicaid under the Affordable Care Act last fall, but Republican legislatures in both those states are seeking ways to roll back those expansions; women sought out long-acting reversible contraception after the election of President Trump; a California coalition of health, labor, and education leaders cited a dearth of healthcare workers in recommending a workforce investment plan calling for spending up to $3 billion over 10 years to address the shortfall.

While President Trump's State of the Union address is not finalized, he may plan to unveil a promise to end HIV transmission in America by 2030; a federal judge dismissed a lawsuit brought by Maryland that claimed the Trump administration is failing to enforce the Affordable Care Act; new cystic fibrosis (CF) treatments targeting the genetic mutations that cause the disease help about 90% of patients, meaning that 10% are still waiting for a cutting-edge therapy.

A recent report from the Government Accountability Office (GAO) found that claims costs and federal and state policies largely influenced insurer participation in exchanges during the early years of the Affordable Care Act (ACA).

President Trump’s latest healthcare proposal could have the effect of raising out-of-pocket drug costs for some while lowering them for others; FDA Commissioner Scott Gottlieb said it is shocking to him that the rate of young people addicted to using e-cigarettes, or vaping, had reached levels at which FDA-approved methods for quitting e-cigarettes could be necessary; "Medicare for More,” not Medicare for All, is likely to emerge as Democrats jockey for 2020 with a watered-down version of universal health care.

CMS is proposing more changes to the Affordable Care Act (ACA), including ways to seek to end the practice of silver loading, end automatic re-enrollment in individual exchange plans, and raise premiums by 1%, it said in its proposed 2020 Payment Notice.

As expected, California and 16 other states defending the Affordable Care Act (ACA) in a federal lawsuit announced they will appeal last month’s ruling by a Texas judge that declared the ACA unconstitutional.

The federal judge who ruled last month that the Affordable Care Act (ACA) was invalid issued an order over the weekend that the law will remain in effect pending appeal; pharmacies and businesses with pharmacies in New York City will no longer be allowed to sell cigarettes and other tobacco products; a federal judge has blocked the administration's cut to the 340B program.

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

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.

A federal judge in Texas ruled that the Affordable Care Act's individual coverage mandate is unconstitutional and that the rest of the law must also fall, likely setting up a fight in the Supreme Court and throwing into question the idea that consumers should have protection against discrimination by insurers for having pre-existing health conditions.

This week, the top managed care news included a report that found uninsured rates were on the rise in 2017; an analysis of rising health insurance costs for families; predictions for cardiology trends in 2019.