Morning Consult Health, Presented by Men Against Breast Cancer Fund: Senate Clears Bill Changing Obamacare’s Definition of Small Employer; Funds Fall $2.5 Billion Short for ACA Insurers That Suffered Losses on Exchanges

By Deirdra O’Regan

Today’s Washington Brief

  • The Senate cleared a measure that would change Obamacare’s definition of a small employer, a rare example of bipartisan agreement on how to revise the Affordable Care Act. The tweak is intended to protect small and midsize businesses from increases in health insurance premiums, and President Obama is expected to sign it into law. (The New York Times)
  • Opponents of Obamacare’s so-called “Cadillac tax” are struggling to find a politically viable replacement which would pay for the $87 billion the tax is projected to generate over 10 years. Meanwhile, economists and health experts have drafted a letter defending the tax and saying it will slow the rise of healthcare costs. (Morning Consult)
  • The Heritage Foundation’s Paul Winfree uses his knowledge of the congressional budget process to attack those who may appropriate it for political ends. His latest target is Rep. Steve Scalise (R-La.), who wants to use the budget reconciliation process as a way to defund Planned Parenthood. (Morning Consult)

Today’s Business Brief

  • Health insurers that lost money on Obamacare exchanges in 2014 will receive only a portion of their promised safety-valve payments. But the Centers for Medicare and Medicaid Services expects that the $2.5 billion still owed to insurers will be covered in 2015 and 2016. (Modern Healthcare)
  • Out-of-network providers charged patients on average 300 percent more than the Medicare rate for certain treatments or procedures, according to new research. Some treatments were even more exorbitant, charging nearly 1,400 percent more. (Kaiser Health News)
  • The Food and Drug Administration approved the first combination of drugs designed to help the immune system fight inoperable skin cancer. The combination regimen of immuno-oncology drugs Opdivo and Yervoy could cost $256,000 a year. (Reuters)

Today’s Chart Review

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Friday
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General

Paul Winfree Is Dangerous
Rob Kunzig, Morning Consult

Most people wouldn’t be scared of Paul Winfree. He has a boyish face. He dresses like a Sunday School teacher. If you needed to leave your child with a stranger for 10 minutes, Winfree would be a safe bet.

House GOP presses Planned Parenthood with new questions
Peter Sullivan, The Hill

Republicans on the House Energy and Commerce Committee are asking new questions of Planned Parenthood concerning how it oversees fetal tissue donation at its affiliates. The committee released a letter from Chairman Fred Upton (R-Mich.) to Planned Parenthood President Cecile Richards on Thursday, two days after Richards testified at a contentious hearing in front of a separate committee.

Stocks Rally With Crude Before Payrolls as China Nerves Subside
Nick Gentle and Daniel Tilles, Bloomberg News

European stocks rose, erasing a weekly decline, and U.S. equity-index futures advanced with oil before a U.S. jobs report that may provide clues as to the timing of the Federal Reserve’s first interest-rate increase in nine years. Gains on the Stoxx Europe 600 Index were led by energy, technology and insurance shares, while Standard & Poor’s 500 Index E-mini futures signaled the benchmark gauge may extend a three-day rally, what would become the longest run since mid-July.

Payers

Health Law Revision Is Approved
Robert Pear, The New York Times

The Senate passed legislation on Thursday intended to protect small and midsize businesses from increases in health insurance premiums, clearing the bill for President Obama’s expected signature. The action by Congress was a rare example of bipartisan agreement on how to revise the Affordable Care Act.

Lawmakers Who Dislike Cadillac Tax Can’t Agree on How to Repeal It
Jon Reid, Morning Consult 

Democrats have found themselves in a difficult position concerning Obamacare’s so-called “Cadillac tax.” They want to repeal it, but there are no politically viable replacements. Most Democrats say a condition of repealing the tax is finding a way to pay for the $87 billion it is projected to generate over 10 years.

ACA pool to ease health insurers’ losses falls $2.5 billion short
Bob Herman, Modern Healthcare

Health insurers that sold plans and lost money on the Affordable Care Act’s exchanges in 2014 will only receive a portion of their promised safety-valve payments, according to government data released Thursday. The CMS expects that the $2.5 billion still owed to insurers will be covered in 2015 and 2016.

House Republicans investigate struggling ObamaCare co-ops
Sarah Ferris, The Hill

The House Ways and Means Committee is launching a probe into ObamaCare’s startup insurers, known as co-ops, which Republicans warn could collapse before repaying government dollars. “We have long been concerned about the financial solvency of CO-OPs,” three subcommittee chairmen wrote in a letter to the Department of Health and Human Services on Wednesday.

Insurers Find Out-of-Network Bills As Much As 1,400 Percent Higher
Anna Gorman, Kaiser Health News

Out-of-network providers charged patients on average 300 percent more than the Medicare rate for certain treatments or procedures, according to the analysis of 2013 and 2014 claims data released Thursday by the America’s Health Insurance Plans. The industry group, which supports limiting out-of-network charges, found that some treatments were even more exorbitant — with out-of-network providers charging nearly 1,400 percent more than what is reimbursed by Medicare.

Providers

Newly Insured Treasure Medicaid, But Growing Pains Felt
Sarah Varney, Kaiser Health News

The Affordable Care Act unleashed a building boom of community health centers across the country. At a cost of $11 billion, more than 950 health centers have opened and thousands have expanded or modernized.

Cone Health joins systems wading into insurance
Beth Kutscher, Modern Healthcare

Cone Health is joining the ranks of health systems entering the insurance business as it begins to market its new Medicare Advantage plan this week. The Medicare Advantage product represents its first venture into the insurance market.

Doctors often uncomfortable soliciting donations from patients
Kathryn Doyle, Reuters

Many doctors are asked to seek donations from grateful patients after successful cancer treatment, but most physicians are uncomfortable with this idea and feel a conflict of interest, according to a new study. Donations from grateful patients made up approximately 20 percent of all philanthropic contributions to healthcare centers, totaling nearly $1 billion in 2009.

Teach Patients How to Communicate Symptoms Better
Joyce Frieden, MedPage Today

Helping patients communicate their symptoms clearly could go a long way toward making an accurate diagnosis, John Ely, MD, MPH, said at the annual meeting of the Society to Improve Diagnosis in Medicine. Ely, a family physician who is retired from the University of Iowa in Iowa City and has been a patient himself recently, said he “got to thinking about what a good patient would do.”

Pharma, Biotech & Device

FDA approves costly Bristol-Myers drug combo for melanoma
Bill Berkrot and Vidya L Nathan, Reuters

The U.S. Food and Drug Administration on Thursday approved the first combination of two drugs that help the immune system fight cancer, a therapy regimen that could cost $256,000 a year. Bristol-Myers Squibb Co said the FDA had given the green light to combine its immuno-oncology drugs Opdivo and Yervoy to treat advanced or inoperable melanoma, the deadliest form of skin cancer, in patients who do not have a mutation of a gene called BRAF.

Russian Drugs Pass as Supplements in U.S.
Kristina Fiore, MedPage Today

Two pharmaceutical-grade drugs are being marketed as brain-boosting botanical supplements, researchers found. Both vinpocetine and picamilon are prescribed as cerebrovascular drugs in several other countries, but are sold as nutritional supplements in the U.S. and marketed to improve focus and memory.

Novartis biosimilar copycat takes aim at Amgen’s drug Enbrel
Michael Shields and Ben Hirschler, Reuters 

The U.S. Food and Drug Administration has accepted Novartis unit Sandoz’s regulatory submission for approval of a biosimilar copy of Amgen’s blockbuster Enbrel drug, the Swiss drugmaker said on Friday. Biosimilars aim to copy biologic products, which are made inside living cells, but they can never be exact duplicates, so biosimilar manufacturers need to conduct clinical trials to show their products work as intended.

Xenoport to seek partner to develop drug; CEO steps down
Rosmi Shaji, Reuters 

Xenoport Inc said it would stop developing on its own a drug that showed high rates of side effects in a study and instead focus on its treatment for restless leg syndrome. The company also said on Thursday that Ronald Barrett, its chief executive since 2001, has stepped down and will be succeeded by Chief Operating Officer Vincent Angotti.

Health IT

ICD-10 has kind of been like Y2K, so far …
Joseph Conn, Modern Healthcare

Some 32 years after work began on developing the International Classification of Diseases 10th Revision of diagnostic and procedural codes, most providers, many with fingers crossed, jumped off the ICD-10 pier at midnight Thursday. And by most accounts, the first 12 hours have gone off without a hitch.

Analytics can mitigate ICD-10 downside
Mike Miliard, Healthcare IT News

Smart analytics will be critical to making sure that setback is as minor as possible. As ICD-10 becomes the new reality, providers will need to suss out trend lines and spot outliers, fixing problems as they see them. They’ll have track coding and billing efficiency and ensure accurate physician documentation. Benchmarking – internally and compared with peers – is essential.

A Message from Men Against Breast Cancer Fund:

The draft USPSTF breast cancer screening recommendations would limit women’s access to lifesaving breast cancer screening exams. With one in eight woman developing breast cancer in her lifetime, the earlier we detect cancer, the better. We stand with 13 organizations in urging Congress to stop the guidelines and pass the bipartisan Protect Access to Lifesaving Screenings (PALS) Act (S. 1926/H.R. 3339), which would place a two-year moratorium on implementing the recommendations. Learn more.

Opinions, Editorials & Perspectives

Is Tax Time a Key Component to Maximizing Enrollment?
Anne Filipic, Morning Consult

Earlier this year, consumers went through the tax filing season for the first time since the coverage expansion provisions of the Affordable Care Act took effect. Now that taxes and health coverage are more connected than ever, we at Enroll America knew it would be an important learning opportunity – especially after the U.S. Department of Health and Human Services announced a special enrollment period for consumers facing the fine.

Don’t Repeal the Cadillac Tax
Ezekiel J. Emanuel and Bob Kocheroct, The New York Times

Surprisingly, there appears to be one small area of bipartisanship in Washington: the desire to repeal the so-called Cadillac tax. It is a tax on super-expensive health insurance plans provided by some private companies to their employees.

How to reduce drug prices: Our view
The Editorial Board, USA Today

For fresh evidence that prescription drug pricing is out of whack, look no further than the recent case of Martin Shkreli, the hedge fund manager turned pharmaceutical CEO. Shkreli announced that his company would abruptly increase the cost of a 62-year-old drug, used to treat a life-threatening parasitic infection, from $13.50 per pill to $750.

Why I should have brought a box of tissues to Mayo Transform
Nicole Oran, MedCity News

When you think of massive healthcare conferences, many might expect to hear from speakers who are physicians, entrepreneurs, investors and CEOs. At Mayo Clinic’s Transform, this is true to some degree, but there is a different, more sensitive and compassion-driven vibe. Some of us are getting a little choked up.

Meeting the Challenge of Immunizations
Yul Ejnes, MedPage Today

One of the most significant trends in immunization is the expanding role of pharmacists in administering vaccines. This topic could take up a couple of columns. It pits increasing access against decreasing fragmentation of care.

A Message from Men Against Breast Cancer Fund:

With one in eight women developing breast cancer during her lifetime, the earlier we can detect breast cancer, the better. Yet, draft USPSTF breast cancer screening recommendations would limit women’s access to mammograms, putting more than 22 million women and their families at risk. We stand with 13 organizations in urging Congress to pass the bipartisan Protect Access to Lifesaving Screenings (PALS) Act (S. 1926/H.R. 3339) to stop the guidelines for two years. Learn more.

Research Reports, Issue Briefs & Case Studies

Charges Billed by Out-of-Network Providers: Implications for Affordability
America’s Health Insurance Plans

Our study identified a pattern of average billed charges submitted by out-of-network (OON) providers that far exceeded Medicare reimbursement for the same service performed in the same geographic area. These findings reinforce conclusions from our previous reports that used the three highest billed commercial charges in a geographic region.

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