The Hill reports tonight that the President and Congressional leadership have reached a two year budge deal that also suspends the federal debt ceiling until July 31, 2021.  The House and Senate will seek to pass the budget deal and send it to the President for his signature before the August recess.The faster this legislative act can be completed, the sooner the August recess will arrive.

Healthcare Dive reports on U.S. District Judge Richard Leon’s Tunney Act hearing on the fairness of the Justice Department’s resolution of antitrust issues stemming from last year’s CVS Health acquisition of Aetna. The hearing was held last Friday July 19 in federal court in Washington DC.  Of note,

Several of [Judge] Leon’s questions during oral argument suggested he might consider anticompetitive harms outside the Tunney Act as a basis to reject the settlement.

The judge seemed particularly interested in AIDS Healthcare Foundation lawyer Christopher Casey’s suggestion of additional remedies that could be put into place on top of the divestiture of the PDP plans the companies were already required to complete.

Those proposed remedies included requiring CVS allow all rival pharmacies access to to its pharmacy network, allowing all Aetna plan members to opt out of using CVS mail-order pharmacy and allowing all managed care companies access to the CVS Caremark PBM.

Of course, a district court decision invoking such remedies would send the case up to the U.S. Court of Appeals for the D.C. Circuit for review.

Congress remains in session this week on Capitol Hill. As Politico reports, the Trump Administration continues to negotiate with Congressional leaders on a two year budget and debt limit increase deal as the August recess grows nearer.

Health Payer Intelligence offers some perspective on the House vote last week to repeal the Affordable Care Act’s high cost plan tax. The Stop the HIT Coalition commended the House vote while urging Congress also to further suspend or repeal the ACA’s health insurer tax (“HIY”). Healthcare Dive notes that “Insurers are expected to increase premiums by roughly 2% to recoup the cost of the tax as they face an estimated $16 billion fee next year, according to consultancy Oliver Wyman.”  Here’s a link to the Oliver Wyman report.

Fierce Healthcare informs us that “The National Quality Forum and Blue Cross Blue Shield Association have teamed up to launch a new playbook aimed at growing access to medication-assisted treatment (MAT) for opioid addiction.” Check it out at this link.

U.S. District Judge Richard Leon, who also is hearing the Aetna / CVS merger case, rejected today a legal challenge to a Trump Administration rule expanding the available length of coverage for short term health insurance coverage. The FEHBlog found the opinion to be quite convincing.  The plaintiffs plan to appeal. The FEHBlog is pleased with the outcome because it allows more consumer choice.

The clinical trial of the company’s HemoCare Hemodialysis System for the administration of home hemodialysis will involve up to 70 patients at 10 sites, CVS said. Home hemodialysis helps facilitate longer, more frequent dialysis treatments compared to in-center treatments, according to the company.

Health Payer Intelligence brings us a discussion of CMS initiatives implementing the President’s executive order on improving American kidney health.

The Boaston Globe reports that

A decade-old experiment to put a dent in Massachusetts health care costs by changing the way doctors are paid appears to be working — offering a potential strategy to combat one of the most vexing problems in today’s economy.

In a new study, researchers at Harvard Medical School found that a payment plan from Blue Cross Blue Shield of Massachusetts that rewards doctors who control costs is linked to smaller increases in health care spending and better-quality care.

Blue Cross’s payment program gives doctors a fixed amount of money to take care of their patients. When doctors stay on budget and improve care, they can earn bonuses. If not, they can be penalized.

That’s good news.

In other New England news, the Middletown (CT) News reports that

“Insurers that sell policies on Connecticut’s Affordable Care Act exchange, Access Heath CT, are seeking premium increases for their 2020 policies, basing their requests largely on a new federal tax that will be imposed next year.”

This is not a new federal tax. It’s a resurrected federal tax. The onerous health insurance tax created by the Affordable Care Act applied to insured plans, including most FEHB plans, from 2014 through 2016. Congress suspended the tax for 2017, permitted its resurrection for 2018, suspended it again for this year, and evidently plans to permit the tax to kick in again for next year. The Stop the HIT website has details. That’s bad news.

CNBC reports on an interesting Amazon Pillpack controversy with the “players” in the drug supply chain.

According to two people familiar with the matter, PillPack was informed this week that it will soon be cut off from accessing that data via a third-party entity, ReMy Health — a move that could seriously complicate its business. Amazon is considering legal action against Surescripts to halt those efforts, said the people, who asked not to be identified because the deliberations are confidential. One person told CNBC that PillPack has already sent a cease-and-desist letter to Surescripts.

CNBC reports that the House of Representatives voted by a wide majority of 397-31 votes to repeal the Affordable Care Act’s self-defeating high cost plan tax (H.R. 748).  If the Senate does not quickly approve this clean bill and send it to the President for his signature, the FEHBlog will eat his hat.

The House giveth; the House taketh away. Healthcare Dive informs us that the House Energy and Commerce Committee today cleared for full House consideration an amended version of its no surprise billing act (H.R. 3630) —

The change comes from Rep. Raul Ruiz, D-Calif., and will let either providers or payers appeal to an independent arbiter in cases where the median in-network rate exceeds $1,250. Previously, the bill proposed establishing a benchmark payment rate to resolve any disputes.

This bone thrown to out of network providers destroys the bill’s opportunity for lowering health care costs. The Senate bill (S. 1895) does not include this time bomb.

Today, the Internal Revenue Service took a step to implement the President’s recent executive order on health care pricing and quality transparency by issuing IRS Notice No. 2019-45.  This notice, which took effect immediately, permits certain chronic disease related services to be covered under high deductible health plans before the deductible. This favorable change should make these sensible policies which can be coupled with health savings accounts more appealing to consumers. Time will tell.

The Health and Human Services Secretary Alex Azar issued a statement today on the encouraging news that “the Centers for Disease Control and Prevention’s National Center for Health Statistics released provisional counts of overdose deaths in the United States showed a decline of 5.1 percent between 2017 and 2018.” Still way to high, but moving down.

Check out this Employee Benefit News article based on an interesting study conducted by Optum and the National Business Group on Heath

For decades, employers and benefit managers have thought of well-being programs as one-dimensional with the focus on physical health, only offering benefits like on-site fitness centers, gym discounts or a health program that encourages more movement.

But now, in a highly competitive marketplace where employers are looking to attract and retain motivated and productive employees, the idea of well-being programs is expanding and evolving. Just focusing on physical health won’t cut it anymore. Rather, employers are now seeking out innovative workplace well-being programs that encompass five aspects of health: physical, mental, financial, social and community.

Overall employee well-being matters. Newly released data shows that employees who are offered programs that address most or all of the five aspects of well-being are significantly more likely to say their job performance is excellent, they have a positive impression of their employer and would recommend their company as a place to work.

The FEHBlog was curious about what’s going on with the Justice Department’s lawsuit seeking judicial approval of its settlement of the CVS Health / Aetna merger. Here’s the most recent procedural order from the federal court in the District of Columbia, thanks to the government’s PACER service:

MINUTE ORDER. On the Court’s own motion, it is hereby ORDERED that the hearing scheduled for July 17, 2019, on the United States’ Motion for Entry of Final Judgment, is rescheduled to July 19, 2019, at 3:00 pm in Courtroom 18. The Court will hear oral argument from the parties and amici on that date. The United States, CVS Health Corporation, the American Medical Association, and the AIDS Healthcare Foundation will each be permitted fifteen minutes to present their respective arguments. Consumer Action and U.S. PIRG, which have filed briefs jointly and which proffered their hearing witness jointly, will collectively have ten minutes to present argument. Plaintiffs California, Florida, Hawaii, Mississippi, and Washington have filed a request to collectively address the Court for ten minutes at the hearing, and that request is hereby GRANTED. SO ORDERED. Signed by Judge Richard J. Leon on 7/8/2019.

Federal News Network reports on how the Trump Administration is using an OPM information system outage last week to support its proposal to merger OPM’s operations (other than policy) into GSA.

The incident occurred within the data center at the agency’s headquarters, an OPM spokeswoman said. The incident triggered OPM’s automated disaster recovery systems, which shut down “multiple OPM capabilities” and began the process of transferring those capabilities to a backup location, the agency said. 

“Unfortunately, some of the backup systems failed to operate as designed. There is no indication of malicious activity that led to this outage,” the OPM spokeswoman said. “The backup system just failed to respond when called into action.” 

Acting OPM Director Margaret Weichert is expected to brief senators on this incident, the agency’s broader IT challenges and the status of the OPM-GSA merger on Wednesday, a person close to the meeting told Federal News Network. 

Some sources said Weichert is using this IT problem as yet another example of the “poor” state of OPM’s systems. But sources say the administration is exaggerating both this problem and the overall state of OPM’s technology.

Fierce Healthcare reports that the Congressional Budget Office gave the green light to the Senate Health Education Labor and Pensions Committee’s bipartisan bill to lower healthcare costs (S. 1895). Next stop Senate floor.

The Washington Post released an exhaustive story tonight on sales of opioid based prescription drugs over the period 2006 through 2012 when the dispensing pendulum was reaching its peak. The data was released by the federal court hearing a massive opioid related action against prescription drug manufacturers and wholesale distributers.

In the Cleveland case, [consolidating over 2,000 individual lawsuits, U.S. District Judge Dan] Polster has been pressing the drug companies and the plaintiffs to reach a global settlement so communities can start receiving financial assistance to mitigate the damage that has been done by the opioid epidemic.

Wow.

The FEHBlog read today in the Hill that

The House [of Representatives] will vote [this] week on a full repeal of ObamaCare’s Cadillac Tax on high-cost health insurance plans, House Majority Leader Steny Hoyer (D-Md.) announced [last] Friday 

The politics: The Cadillac Tax is the rare part of ObamaCare that both parties largely agree on: They don’t like it. So the repeal vote is expected to be widely bipartisan.
The Cadillac Tax is widely supported by health economists who view it as a way to control health care costs, but it is hated by unions and employers alike, as well as many lawmakers.  Health economists are not a very strong lobbying force in Washington!

If the Democrat-controlled House passes this bill, it should be a shoo in for passage in the Senate, shouldn’t.

It’s a shame that Congress can’t seem to get its act together to repeal other self-defeating ObamaCare taxes like the health insurer fee which is scheduled to resume next year.  Better something, than nothing though.

Congress remains in session on Capitol Hill this coming week. CNBC is reporting that the Treasury Department is urging Congress to raise the national debt limit before Congress leaves town for its August recess.

One of the craziest provisions of the Affordable Care Act is its excise tax on high cost health plans a/k/a the Cadillac tax or HCPT. The Kaiser Family Foundation last week issued a report on that tax which originally was to take effect for 2018 and due to statutory delays is not set take effect for 2022. The report states

When the HCPT takes effect in 2022, an estimated 21% of employers offering health benefits will have at least one plan whose premium and account contributions would exceed the HCPT threshold (Figure 1). When potential FSA contributions are included, the percentage climbs to 31%.

The FEHBlog also took note of the following

The HCPT is a tax on employers based on the value of plans they provide in excess of designated thresholds, originally set at $10,200 for single coverage and $27,500 for family coverage. These caps grow annually with inflation. The CBO estimates that the thresholds will be $11,200 for individual coverage and $30,100 for family coverage when the law takes effect in 2022. Some employers with workers in high-risk industries or older workers face higher caps.  

The HCPT may lead employers to take advantage of the Trump Administration’s offer to send their employees into the ACA marketplace.

An Oregon newspaper, the News Guard, reports that Oregon and 29 other states reached a $10 million settlement with Premera Blue Cross over a data breach ==

From May 5, 2014-March 6, 2015, a hacker used a “spear phishing” email to gain access to the Premera network containing personal information of over 10 million consumers nationwide.

The House Energy and Commerce Health Subcommittee cleared a package of ten healthcare bills on a bipartisan basis. The package includes a no surprise medical charges bill which is similar in approach to the provision found in the bipartisan Senate bill, S. 1895. The House package is discussed in this Healthcare Leaders Media article. Many of these House bills may wind up in the S. 1895 lower healthcare costs bill winding its way through the Senate.

The Federal Times reports this afternoon that

In a 220 to 197 vote that fell primarily on party lines, the House voted to pass the fiscal year 2020 National Defense Authorization Act that includes provisions to grant federal employees 12 weeks of paid family leave and to block the breakup of the Office of Personnel Management.  The legislation now must be reconciled with the Senate version of the same bill, which does not include the family leave or OPM amendments.

The FEHBlog doubts that these non-defense items will wind up in the final bill.

The FEHBlog also doubts the numerous press reports that the President’s initiative to end prescription drug rebates in favor of lower drug prices is dead. Yes, there will be no mandate imposing this initiative on Medicare Part D and exchange plans for 2020 and it’s a good thing that the Administration listened to industry. Nevertheless, Fierce Healthcare reports that the initiative continues to percolate. It’s a long game. The Wall Street Journal adds

Even if no meaningful action passes, the political storm has the ability to hamper sales growth at drugmakers. Price increases for branded drugs lately have slowed from recent years, both in number and magnitude. Wariness of the regulatory environment has likely played a role in that shift. Don’t expect this game of regulatory Whac-A-Mole to wrap up any time soon.  

Seven years after Medicare was enacted in 1965, Congress extended Medicare coverage to Americans under age 65 with end stage renal (kidney) disease (ESRD).  If you build it they will come and now over 45 years later, dialysis center for treating ESRD are nearly as plentiful as Starbucks outlets. A 2018 Congressional Research Service report explains

Medicare spends far more on medical services for beneficiaries with ESRD than for other beneficiaries. In 2013, Medicare spent $61,996 per ESRD beneficiary, compared to $9,889 per non-ESRD beneficiary.29 Medicare per-capita spending for all beneficiaries was $10,478 in 2013, the most recent data available.

At the very end of the nearly two hour long oral argument today, Circuit Judge Jennifer Walker Elrod (a George W. Bush appointee) asked the attorney for the State of California, the lead defendant intervenor state, an intriguing question. She asked him whether the State would object to a Fifth Circuit ruling strikng down the individual mandate, which has been zeroed out, but leaving the remainder of the Affordable Care Act in force. California’s attorney replied the State would have no issue with that outcome because that is the outcome that the 2017 Congress intended when it passed the tax law zeroing out that mandate. That strikes the FEHBlog to be the likely outcome here.