Skip Navigation

Close and don't show again.

Your browser is out of date.

You may not get the full experience here on National Journal.

Please upgrade your browser to any of the following supported browsers:

Just Another Medicare Monday - Health Care Edge: Brought to you by America's Biopharmacetical Companies Just Another Medicare Monday - Health Care Edge: Brought to you by Am...

This ad will end in seconds
Close X

Not a member? Learn More »

Forget Your Password?

Don't have an account? Register »

Reveal Navigation


Just Another Medicare Monday - Health Care Edge: Brought to you by America's Biopharmacetical Companies

Just Another Medicare Monday

By Sam Baker, Sophie Novack and Clara Ritger


ALL MEDICARE, ALL THE TIME: If you've been waiting for a Medicare-driven news cycle, you're about to have an awesome week. Today will bring the first real fallout from CMS' proposed cuts to Medicare Advantage, which a bipartisan group of lawmakers has asked the agency to reverse but which, it should be noted, both parties have previously supported -- Democrats in passing the Affordable Care Act, and Republicans in supporting Paul Ryan's budget. And on Wednesday, the House Energy and Commerce Committee holds a hearing on proposed changes to Medicare Part D. Republicans fear the modifications could undermine the popular drug benefit. Meanwhile, in Medicaid news, the Arkansas House will vote for the fifth time on a bill to renew funding for the state's "private option" Medicaid expansion plan Tuesday, after it passed in the Senate last week.

Top Health Care News

MEDICARE ADVANTAGE CUTS: Privately administered Medicare Advantage plans serve around 30 percent of seniors, and cost about 14 percent more than traditional Medicare coverage. The ACA includes about $150 billion in cuts to the program over the next 10 years, to reduce overspending and bring it in line with traditional fee-for-service. (Clara Ritger and Sam Baker, National Journal)

  • CMS announced proposed rates Friday, which could mean a 1.9 percent payment reduction for Medicare Advantage plans in 2015. Final payment rates are set to be released April 7. (Mary Agnes Carey, Kaiser Health News)

  • "CMS based its projections, which will differ across the country based on a variety of factors, on an expected 3.55 percent decline in the Medicare Advantage growth rate factor and an expected decline of 1.65 percent in per capita expenditures in the fee-for-service portion of the senior citizen health care program." (Modern Healthcare)

  • Some say cuts will end up higher than expected, while others argue the impact is overblown and that most plans have kept costs and benefits stable. (Phil Galewitz, Kaiser Health News)

  • A group of bipartisan lawmakers wrote a letter to CMS earlier this month, expressing concern over possible rate cuts.

  • Read the proposed rates here.


MEDICARE PART D: "The administration's proposal would remove the protected status from three classes of drugs that has been in place since the program's inception in 2006: immunosuppressant drugs used in transplant patients, antidepressants and antipsychotic medicines...Three other categories — cancer, H.I.V. and anti-seizure drugs — would retain their status as protected classes and insurance companies would be required to continue covering nearly all drugs in those treatment areas. Medicare has traditionally required the broad coverage because patients with these conditions must often try several drugs before finding one that works." (Katie Thomas and Robert Pear, New York Times)

  • Over 200 groups wrote a letter to CMS last week asking that the rule be withdrawn.

  • Read the proposed rule here.

    Don\'t Miss Today\'s

    Health Care Edge is one of my top resources."

    Meghan, Associate Specialist

    Sign up form for the newsletter


ARKANSAS - MEDICAID IMPASSE HITS NEW HEIGHTS: The state was the first to expand coverage through a compromise plan that uses federal funds to purchase private insurance for low-income individuals. If the House fails to re-authorize the funding, it will also be the first state to take back coverage--from the nearly 100,000 Arkansans who have enrolled in the program so far. (Sophie Novack, National Journal)

  • "Though Democratic Gov. Mike Beebe and Republican leaders remain upbeat about the prospects of continuing the state's "private option," the stalemate that heads into a second week threatens to turn Little Rock into a small-scale version of the Washington budget battle that shut down the federal government for 16 days last year." (Andrew DeMillo, Associated Press)

  • "[Republican House Speaker Davy Carter] continued to maintain that he is '100-percent confident we're going to pass it. ...It will pass, it's just a matter of when.'" (David Ramsey, Arkansas Times)

  • "You think it's hard getting 75 votes for the private option this year? Wait until 2015." (Max Brantley, Arkansas Times)

  • Meanwhile, health centers fear a financial hit from the "private option," since private insurers pay community centers far less than they get from traditional Medicaid. (Phil Galewitz, Kaiser Health News)

MARYLAND - ACA ENROLLMENT GOAL IS MET...THANKS TO A RESEARCH ERROR: The original goal for the state was to have 260,000 Marylanders sign up for private plans or Medicaid during open enrollment period, but in actuality, only 160,000 were expected. So far almost 190,000 have enrolled. (Jenna Johnson, Washington Post)

TEXAS - THOUSANDS IN COLONIAS FALL INTO ACA COVERAGE GAP: Organizations are helping residents fill out a hardship waiver, which exempts those in the coverage gap — individuals who with incomes less than $11,490 a year, or $23,550 for a family of four— from paying a mandate penalty when they file their taxes. (Alexa Ura, New York Times/The Texas Tribune)

CALIFORNIA - OBAMACARE EXCHANGE WEBSITE DOWN: Covered California's website remains down after being taken offline due to software problems Wednesday afternoon. (Victoria Colliver, San Fransisco Chronicle)

  • The state exchange released enrollment numbers last week, which showed good sign-up numbers overall, but the need for greater Latino engagement. (Sophie Novack, National Journal)


ENROLLMENT ON ACA SMALL BUSINESS MARKETPLACE LAGS BEHIND: As enrollment on health law's insurance exchange for the individuals and families picks up speed ahead of the end of open enrollment March 31, small business owners remain slow to choose plans on the small business exchanges. (J.D. Harrison, Washington Post)

EHEALTH HAS HIGH PERCENTAGE OF YOUNG ENROLLEES: Forty percent of the 169,000 people who used the company's site to enroll in insurance plans through the ACA are ages 18-34--significantly higher than the reported 25 percent that enrolled through the state and federal exchange websites. The figures are the first big look at the make-up of those avoiding the often glitchy sites and enrolling in coverage directly through insurers. (Julie Appleby, Kaiser Health News)

Providers and Patients

MEDICARE DATA SHOWS DIFFERENCES IN ACCOUNTABLE CARE ORGANIZATIONS' PATIENT CARE: "Networks of doctors and hospitals set up under the Affordable Care Act to improve patients' health and save money for Medicare are having varying rates of success in addressing their patients' diabetes and heart disease, according to government data released Friday. The release is the first public numbers from Medicare of how patient care is being affected by specific networks." (Jordan Rau, Kaiser Health News)

ORGANIZATION LAUNCHED TO ACCELERATE SHARING OF PATIENT DATA: Companies including Epic, Surescripts, Walgreen, Kaiser Permanente, and Optum (UnitedHealth Group) have joined to form Carequality, part of the organization Healtheway. (Zina Moukheiber, Forbes)


AD CAMPAIGN TARGETS LAWMAKERS OPPOSED TO MEDICAID EXPANSION: Americans United For Change launched a new campaign targeting Nebraska Governor Dave Heineman for turning down Medicaid expansion in the state.

AMERICANS FOR PROSPERITY LAUNCHES MAJOR AD BUY IN ALASKA: And for the first time, it's not focused exclusively on Obamacare. (Alex Roarty, National Journal)


DEBATE OVER E-CIGARETTES AS PATH TO TOBACCO, OR AWAY FROM IT: "The devices, intended to feed nicotine addiction without the toxic tar of conventional cigarettes, have divided a normally sedate public health community that had long been united in the fight against smoking and Big Tobacco." (Sabrina Tavernise, New York Times)

FDA ORDERS FOUR BIDI CIGARETTE BRANDS REMOVED FROM MARKET OVER HEALTH CONCERNS: This is the first time the agency has removed tobacco products since gaining the authority to do so in 2009. (Catherine Saint Louis, New York Times)


COURT RULES AGAINST NOTRE DAME IN ACA CONTRACEPTION CASE: "The 7th U.S. Circuit Court of Appeals in Chicago in a 2-1 ruling agreed with a lower court that had turned away the school's request for a temporary injunction sparing it from the federal health law's contraception requirement." (Louise Radnofsky, Wall Street Journal)

Happening This Week


DISCUSSION ON ARKANSAS AND THE AFFORDABLE CARE ACT: Democratic Gov. Mike Beebe joins Kaiser Health News and Health Affairs for an 8:30 a.m. breakfast to talk about the Medicaid private option, among other health law implementation efforts in the state.


EXAMINING MENTAL HEALTH: TREATMENT OPTIONS AND TRENDS: The full Senate HELP committee meets at 10:00 a.m. in 430 Dirksen.

ARKANSAS HOUSE VOTES ON 'PRIVATE OPTION' PLAN: The House will vote for the fifth time on a bill to renew funding for the state's Medicaid expansion plan at 2:30 p.m (EST).


PROVIDING ACCESS TO AFFORDABLE, FLEXIBLE HEALTH PLANS THROUGH SELF-INSURANCE: The House Education and Workforce Subcommittee on Health, Employment, Labor and Pensions meets at 10:00 a.m. in 2175 Rayburn.

SURGEON GENERAL NOMINATION TO BE DISCUSSED: The Senate HELP committee is holding an executive session in 430 Dirksen at 10:00 a.m. to consider, among other nominations, Vivek Murthy for Surgeon General.

THE EFFECT OF PROPOSED MEDICARE PART D CHANGES ON SENIORS: The House Energy and Commerce Subcommittee on Health gathers in 2123 Rayburn at 10:00 a.m. to evaluate whether CMS's proposed changes will increase costs and reduces choices for Medicare beneficiaries.


PUBLIC HEALTH EMERGENCY MEDICAL COUNTERMEASURE ENTERPRISE: The House Appropriations Oversight Subcommittee gathers at 10 a.m. in 2358-C Rayburn with federal agencies to evaluate preparedness and response.

COUNTERFEIT DRUGS: FIGHTING ILLEGAL SUPPLY CHAINS: The House Energy and Commerce Subcommittee on Oversight and Investigations is holding a hearing at 10:00 a.m. in 2322 Rayburn. Among the federal agencies represented at the hearing are the FDA, Homeland Security and the GAO; others testifying include the Institute of Medicine, Pfizer, and Eli Lilly.

CARE INNOVATION SUMMIT: The Aspen Institute and the Advisory Board Company convene policymakers, providers, and leading innovators to explore opportunities to drive higher-value care and better health for individuals and populations.


Don\'t Miss Today\'s

Health Care Edge is one of my top resources."

Meghan, Associate Specialist

Sign up form for the newsletter
comments powered by Disqus