American Medical Association urging replacement before repeal

On the Hill

The American Medical Association (AMA) is urging Congress to hold off on repealing the Affordable Care Act until lawmakers have a replacement plan. In a letter to congressional leaders, AMA’s CEO James Madara encouraged Congress to create an outline of any official plans for maintaining healthcare coverage, arguing that the public should be able to compare any replacement model to Obamacare’s current provisions. The letter is the strongest position taken by the AMA yet on the Republicans’ plan to repeal and replace. It has signaled a willingness to alter parts of the healthcare system but warned that changes must maintain Obamacare’s coverage and increase insurance affordability.

At the agencies

The Centers for Medicare and Medicaid Services (CMS) has announced its intent to work with stakeholders on reporting quality measures for groups of beneficiaries with social risk factors. This comes after a report from the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation revealed that beneficiaries with social risk factors had worse outcomes and providers that treat a disproportionate number of these beneficiaries tended to perform worse on quality measures. The report suggested CMS could leverage value-based pay programs to both assist providers treating these beneficiaries and improve health outcomes. The report found that these factors are influential and to make improvements, the social risk factors needed to be explicitly measured and recorded.

According to a new report from the HHS Office of Inspector General, high-priced drugs are largely responsible for the large increase in Medicare Part D “catastrophic” spending over the past five years. Federal payments for catastrophic coverage exceeded $33 billion in 2015, a threefold increase from 2010. Drugs costing more than $1,000 per month accounted for two-thirds of the spending with ten drugs accounting for one-third of payments. The increase comes from the 80 percent of drug costs the government pays once Medicare Part D beneficiaries reach their catastrophic threshold.

In the courts

A D.C. federal judge declined to rescind an order requiring the Department of Health and Human Services (HHS) to clear a large backlog of hospital billing claims. The rejection of an HHS motion maintained the order issued last month requiring the agency to eliminate its 650,000-claim backlog before 2021. HHS had argued that it would only be able meet the deadline by paying Medicare claims without regard to merit, which was strengthened by Congress failing to earmark funds to tackle the backlog before adjourning in December. However, the judge dismissed the argument and cited a D.C. Circuit opinion that had previously created the court ordered timetable for backlog relief.

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