Health Care Checkup: June 24, 2022

Health Care Checkup

June 24, 2022

THE BIG PICTURE

On Friday morning, the Supreme Court of the United States (SCOTUS) upheld a Mississippi ban on abortions performed after 15 weeks of pregnancy on a 6-3 vote, and on a narrower 5-4 basis, to eliminate the federal right to abortion established nearly 50-years ago under Roe v. Wade. The complete ability to regulate and even prohibit abortions will now fall to individual states. Justice Samuel Alito wrote the majority opinion, which said that “The Constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision, including the one on which the defenders of Roe and Casey now chiefly rely — the Due Process Clause of the Fourteenth Amendment.” Justices Stephen Breyer, Sonia Sotomayor and Elena Kagan dissented, and wrote, “With sorrow — for this Court, but more, for the many millions of American women who have today lost a fundamental constitutional protection — we dissent.”

Late this week, Congress passed legislation designed to improve gun safety, school safety, and mental health services. Thursday evening, the Senate voted 65-33 to pass the bipartisan Safer Communities Act, the most sweeping gun safety package to pass the chamber in decades. 15 Republicans joined all Senate Democrats in voting for the bill. Then, on Friday, the House voted 234-193 to approve the bill, with 14 Republicans voting with Democrats. The legislation invests millions of dollars in mental health funding and requires the Department of Health and Human Services (HHS) to provide guidance to states on how to expand telehealth under Medicaid and the Children’s Health Insurance Program (CHIP). The bill would also enhance background checks for individuals under the age of 21, support state red flag laws, close the “boyfriend loophole,” and invest in community violence intervention. The legislation will now head to President Joe Biden to be signed into law.

On Wednesday, Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) announced their new bipartisan legislation, the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, to lower the costs of insulin. The INSULIN Act would ensure that pharmacy benefit managers (PBMs) and insurance plans cannot collect rebates on insulin. Such rebates have the potential to increase the cost of the drug for the consumer. Additionally, the legislation would limit copays and coinsurance of insulin to no more than $35 per month and ensure that prior authorization requirements not be imposed on the beneficiary to limit use. Senate Majority Leader Chuck Schumer (D-NY) said that he will bring the bipartisan legislation to the Senate floor soon for a vote. A one-pager on the legislation is available here, and a section-by-section summary is available here.

The Biden Administration released a “Blueprint for Addressing the Maternal Health Crisis.” The Blueprint outlines five initiatives the Administration is focusing on to help improve maternal health outcomes in the U.S. These priorities include increasing access to maternal health care, ensuring women giving birth have a voice, advancing data collection, strengthening the perinatal workforce, and improving economic and social supports for pregnant women. Additional information can be found here.

The Centers for Medicare and Medicaid Services (CMS) approved Colorado’s Section 1332 State Innovation Waiver request to create the “Colorado Option.” The Colorado Option would be the first of its kind in the nation and would be a state-specific health coverage plan aimed at increasing access to health care and reducing health disparities. More can be found here.

What to Expect Next Week: Congress will embark of its July 4 Congressional recess and will return to session the week of July 11. Due to the Congressional recess, our next Health Care Checkup will be distributed on Friday, July 15.

There will be several health-related hearings next week. On Monday, the House Committee on Oversight and Reform will hold a hearing titled, “Examining the 2022 National Drug Control Strategy and the Federal Response to the Overdose Crisis.” On Tuesday, the House Energy and Commerce Subcommittee on Oversight and Investigations will hold a hearing on “Protecting America's Seniors: Oversight of Private Sector Medicare Advantage Plans.” On Wednesday, the House Energy and Commerce Subcommittee on health will hold a hearing on “Investing in Public Health: Legislation to Support Patients, Workers, and Research.”

DEEP DIVE

SCOTUS Ruling Ends Federal Right to an Abortion

Congress Passes Historic Gun Safety Legislation

Diabetes Caucus Co-Chairs Unveil Insulin Bill that would Cap the Out-of-Pocket Cost of Insulin at $35 Per Month

HHS Releases Fact Sheet on Potential Impact to Marketplace Premiums if Congress Does Not Extend American Rescue Plan Subsidies

On Wednesday, the HHS released a fact sheet on what may happen to health insurance Marketplace premiums if Congress does not extend American Rescue Plan (ARP) premium tax credits, which are slated to expire at the end of this year. As a reminder, the ARP, which President Joe Biden signed into law March 2021, included subsidies to make Affordable Care Act (ACA) Marketplace premiums more affordable for consumers. As a result of the subsidies, a record-breaking 14.5 million people signed up for health insurance coverage during the 2022 Open Enrollment Period. Additionally, more than 90% of the people on HealthCare.Gov received financial assistance, and four out of five people qualified for plans that cost less than $10 per month. HHS warns that if Congress does not extend the subsidies when they are set to expire, the number of uninsured Americans will increase significantly and approximately 3 million Americans could lose their health insurance. The fact sheet released by HHS can be found here.

CMS Issues Proposed Rule that would Update ESRD Payment Rates, ESRD Facilities Could See a 3.1% Payment Bump Under the Proposal

On Tuesday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed payment rule, which would increase Medicare payments in fiscal year 2023 by 3.1% for freestanding dialysis centers and 3.7% for hospital-based facilities. The proposal would also make changes to the ESRD Prospective Payment System (PPS) methodology for calculating the outlier threshold for adult patients. Additionally, the rule proposes to change the definition “oral-only drug” beginning January 1, 2025, to “clarify the descriptions of the ESRD PPS functional categories.” The proposed rule can be found here and the fact sheet from CMS can be found here.

SCOTUS Sides with Employer-Provided Health Plan in Dialysis Reimbursement Case

This week, the Supreme Court of the United States (SCOTUS) ruled 7-2 that employer-provided health plans can make all dialysis providers out-of-network. As a background, in 2018, DaVita, which is one of the country’s main dialysis providers, sued Marietta Memorial Hospital Employee Health Benefit Plan. DaVita alleged that the plan discriminated against individuals with ESRD and violated the Medicare Secondary Payer statute because Marietta’s employee health plan does not include any in-network dialysis provider. However, Justice Brett Kavanaugh wrote in the opinion that, “If Congress wanted to mandate that group health plans provide particular benefits, or to require that group health plans ensure parity between different kinds of benefits, Congress knew how to write such a law. It did not do so in this statute.” Justices Elena Kagan and Sonia Sotomayor dissented, and Kagan wrote “Now Congress will have to fix a statute this Court has broken.”