5 Things That Happened in Health Policy This Week is produced by a mix of research assistants from the Healthcare Quality & Outcomes (HQO) Initiative at the Harvard T.H. Chan School of Public Health. In each edition we feature a variety of news articles, reports, and studies focused on U.S. health policy and health services research.
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On Tuesday, the fourth open enrollment period officially began. Although benchmark premiums have increased, HHS stated that over 85% of consumers will qualify for tax credits and 70% will pay less than $75 per month. Additionally, HHS suggests that 70% of returning consumers could save money by shopping all plans instead of reenrolling in their current plan. And people are enrolling – 60,000 applications were submitted in the first 6 hours of open enrollment, which is a 50% increase since last year. However, some individuals such as Will Denecke have decided to forgo enrolling in a plan and will enroll midyear if their medical needs change. Critics of the ACA have noted that such loopholes that allow for midyear enrollments are one area that needs improvement. Read on for more on who isn’t enrolling.
Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2016 (Emily P. Zammitti, M.P.H., Robin A. Cohen, Ph.D., and Michael E. Martinez, M.P.H., M.H.S.A., CDC, 11/3)
The National Center for Health Statistics at the CDC has released early estimates of health insurance coverage for the first six months of 2016. The report notes that the overall uninsured rate, at 8.9%, was not statistically different from the uninsured rate for 2015 (9.1%). Similarly, trends for adults under 65 were not much different in the first six months of 2016 (12.4%) from 2015 (12.8%). These numbers represent a slowdown in the decline of the uninsured rate compared to prior years, and appear to suggest a slowdown in takeup of insurance plans through the ACA’s exchanges. Indeed, the increase in insurance coverage purchased through exchanges (for those under 65) was statistically insignificant. While these are early estimates and may be revised when full-year data is released, they may also indicate that plans on the ACA’s exchanges, coupled with subsidies and the individual mandate, may still not be attractive enough for the remaining uninsured.
Appeals court revives FTC’s bid to block Advocate/NorthShore merger (Erica Teichert, Modern Healthcare, 10/31)
The struggle over the proposed Advocate Health Care and NorthShore merger continues. On Monday, a federal appeals court ruled that the lower court’s June decision to allow the merger to proceed was “erroneously flawed,” sending the FTC’s challenge back to trial. In the original case, the FTC argued that the proposed geographic market would harm insurers and customers, increasing costs and making it virtually impossible to create a health network for Chicago employers without including at least some NorthShore or Advocate hospitals. The merger will remain on hold until another trial court can reevaluate the geographic market evidence. This is the second recent win for the FTC in challenging big hospital mergers; in September, the proposed merger between Penn State Hershey Medical Center and PinnacleHealth System was also paused by an appeals court and ultimately dropped by the two health systems.
Medicare Diabetes Prevention Program Saves $2,650 per patient (Health Payer Intelligence, 11/3)
CMS recently announced plans to expand coverage for Medicare’s Diabetes Prevention Program to all beneficiaries starting in 2018. The program, which began as a pilot program through the Center for Medicare and Medicaid Innovation (CMMI), is administered through local YMCAs and provides nutrition and diet coaching for those with prediabetes. The curriculum used has successfully prevented onset of diabetes in 58 to 71% of cases. Thus far the program has proven to be cost saving: a $500 investment on average prevents $2650 of spending per beneficiary in the subsequent 15 months. While this program has had great success with participants, there is some concern that many pre-diabetics are undiagnosed and therefore may not seek treatment.
U.S. Charges in Generic-Drug Probe to Be Filed by Year-End (Bloomberg Markets, 11/3)
Suspected price collusion has lead US prosecutors to investigate generic pharmaceutical companies. Two years ago the Department of Justice began investigating and now more than 12 companies and 24 drugs are in the spotlight. Raising drug prices is not illegal, however, competitors coordinating pricing is. Generic drugs account for roughly 88% of prescriptions in the U.S., and in 2015 generics makers brought in about $70 billion in U.S. sales post discounts and rebates to payers. One example of suspected collusion is over the increase in Digoxin pricing in 2013. Lannett raised the price from 17 cents to $1.185, six days later Impax matched Lannett’s price, and Par introduced a version in 2014 also at the $1.185 price. The first charges for collusion could happen as early at the end of the year.