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October 25th, 2021 The Out-of-Pocket Health News Digest

Below you will find briefs about recent health policy news stories. Our hope is for students to have an information outlet at their fingertips to keep up-to-date with the most pressing news stories in health policy. This compilation is produced by the HPSA Education Committee: Brynna Thigpen, Christopher Whitlock, Easheta Shah, Hannah Lane, Hassan Kourani, Jourdan Clements, and Lizzy Peppercorn

No Surprises Act Aims to Protect Patients from Unexpectedly Large Medical Bills by Christopher Whitlock

The days of patients being held responsible for unexpectedly large bills after receiving care from certain out-of-network providers are coming to an end in the months ahead with the No Surprises Act, which takes effect on January 1, 2022. The term “surprise billing” refers to when a patient is unexpectedly charged up to hundreds or thousands of dollars because they unknowingly received care from a provider or hospital outside of their insurance’s network. These situations are often unavoidable in emergencies when patients have no choice of provider or even when they go to an in-network hospital but receive care from a physician who happens to be out-of-network. Insurance companies usually do not cover the entire cost when patients see providers outside their health plan due to exorbitant out-of-network charges, leaving patients responsible for the difference. This practice of “balance billing” is already prohibited under Medicare and Medicaid restrictions. The No Surprises Act is designed to protect consumers from unexpectedly high balance bills by banning surprise billing and requiring health care providers and insurance companies to negotiate unsettled charges between themselves through a new final-offer arbitration process. This law will ensure patients are only responsible for paying in-network rates for emergency services regardless of whether a provider is in or out-of-network. These protections notably exclude ground ambulance transport but cover almost all other situations where out-of-network charges may arise, including air ambulance services and non-emergency care from out-of-network providers in certain in-network facilities. Ideally, this new law will offer peace of mind to patients who may have chosen not to seek necessary medical care due to fear of financial ruin from surprise billing. According to the U.S. Secretary of Health and Human Services Xavier Becerra, “The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises.” Sources: Centers for Medicare & Medicaid Services, NPR, USC-Brookings Schaeffer on Health Policy

Domestic Policy Bill - with Plenty of Health Provisions - Struggles to Take Shape Out of Congress by Brynna Thigpen

Congressional Democrats, with slim majorities in both houses of the legislature, have been working alongside President Biden over the past several months to negotiate and pass a sweeping domestic policy bill, covering everything from subsidized child care, affordable housing, and clean energy tax credits.  Some key health policy provisions that were originally proposed include:  Allocating $35B for child nutrition programs, including adding healthier foods to school meals and making them free for some children Adding vision, hearing, and dental benefits to Medicare  Lowering the eligibility age of Medicare  Permanently expanding Medicaid eligibility to Americans in states which haven’t already done so Permitting Medicare to negotiate drug prices  Investing in maternal, behavioral, and racial justice measures This massive, 10-year spending bill has run into obstacles recently, as two centrist Democratic Senators, Manchin (D-WV) and Sinema (D-AZ), expressed reluctance to support the bill at its initial $3.5 trillion price tag. The 50-50 split in the Senate means that Democrats can’t lose a single vote and still pass the bill, as no Republicans plan to support it.  To get Sinema and Manchin on board, progressive Democrats have offered concessions to reduce the cost, including shortening the time horizon of some programs, limiting the eligibility for programs to only low-income Americans, or funding a smaller number of programs.  Democrats are aiming to complete a compromise on the bill in the coming days. Sources: Wall Street Journal, CNN, CNBC, New York Times

Pfizer Releases Promising News for Children COVID-19 Vaccinations by Jourdan Clements

Pfizer announced that its vaccine is safe and 90.7% effective against symptomatic COVID-19 for children aged 5 to 11. Results from Pfizer’s recent research study of around 2,000 children, of which two-thirds were in the vaccination group and one-third were in the placebo group, revealed only three individuals in the vaccination group contracted COVID-19 as compared to 16 in the placebo group. This data, coupled with previous research from September showing the safety of the COVID-19 vaccine and successful detection of antibodies in vaccinated children, provides support for child vaccination efforts.   Moving forward, Pfizer is seeking FDA emergency use authorization of a two-dose regimen of their 10-microgram dose for children ages 5 to 11. The vaccine doses are advised to be administered three weeks apart.   The US Food and Drug Administration Vaccines and Related Biological Products Advisory Committee is planning to convene on October 26th to determine if the vaccine should be recommended for authorization for those aged 5 to 11. If authorization is approved, this would be the first COVID-19 vaccine available for children below the age of 12.   Pending authorization from the FDA, the Biden administration plans to roll out COVID-19 vaccinations for 28 million children aged 5 to 11 years. This vaccination push will equip 25,000 pediatric and primary care offices, tens of thousands of pharmacies, and hundreds of community health centers and rural health clinics to administer the vaccines. Sources: CNN

One-Liners

Abortion: The Texas Abortion Law appears headed for a review by the Supreme Court following reinstatement by a federal appeals court. The timeline for review is uncertain, but the issue’s urgency may push the case to the top of the court’s agenda by the end of the year (Kaiser Health News). Climate Crisis: A group of medical doctors published a warning in the Lancet that the climate crisis is worsening human health in nearly every quantifiable way, and that the global recovery from the COVID-19 health and economic crisis is worsening matters (USF, The Lancet). Transplant Medicine: Surgeons at NYU Langone Health in New York City successfully transplanted a pig kidney into a human patient without any immediate rejection by the patient’s immune system (CNN).