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The Latest Research, Commentary, And News From Health Affairs

Monday, September 13, 2021

Dear John,

Today's newsletter comes from Katie Keith, principal at Keith Policy
Solutions and faculty member at Georgetown University.

From Katie Keith

The brave editors at Health Affairs have given me the pen for today's
newsletter. So take a deep breath and brace yourself for all things
health policy that I'm watching over the coming weeks.

In Congress

The House will continue to mark up its version of the Build Back Better
Act, which includes historic investments in and changes to Medicare,
Medicaid, the Affordable Care Act, prescription drugs, public health,
and more.

Much of the media focus has been on the addition of new vision, dental,
and hearing benefits to the Medicare program and how to rein in
prescription drug costs. But don't sleep on the Affordable Care Act
subsidy enhancements or filling the Medicaid coverage gap: a recent
study

from the Commonwealth Fund showed that those changes alone would reduce
the uninsured population by 7 million people as soon as next year.

It will be a busy fall tracking this landmark legislation that, if
enacted, will mean big changes to health care.

In the Executive Branch

The Biden administration is working on several new health care coverage
rules.

Following a proposed rule on air ambulances and enforcement that was
issued this past Friday, there will be at least one more new interim
final rule to implement the No Surprises Act. This forthcoming rule will
focus on the independent dispute resolution process that is needed ahead
of 2022 and is being closely watched by health care stakeholders.

Beyond the No Surprises Act, the Biden administration will soon finalize
its first marketplace rule before turning to changes for the 2023 plan
year. The latter rule will be an opportunity to make even bigger changes
aligned with their priorities. And federal officials are looking to roll
back some of the "rules about the rules" adopted in the waning days
of the Trump administration. Those rules made it harder for the agencies
to do things they have always done because of new procedural hurdles to
rule making and guidance.

In the Courts

There continues to be lots of litigation. But I've got my eye on the
Supreme Court's next term which begins in October. Although no case is
as high stakes as last term's California v. Texas, the Supreme Court
has already agreed to hear several important health care cases related
to Section 1557 of the Affordable Care Act, the 340B drug discount
program, and Medicare and Medicaid reimbursement.

(Fun fact: the justices will return to the courtroom for live oral
arguments for the first time since the spring of 2020, but we'll still
get live audio of the arguments so we can keep listening in real time.)

The justices will also reach some sort of decision on the pending
lawsuit on Medicaid work requirements and consider whether to hear a
case about the health insurance tax as it relates to states and Medicaid
managed care plans. All to say, much more to come from the Supreme Court
and beyond.

In the Meantime

Data nerds will delight in additional Census data, out on Tuesday, on
health insurance coverage for 2020. This is an important follow-up to
August data

from the Centers for Disease Control and Prevention that showed a
remarkably stable uninsured rate despite the pandemic. Unlike in past
economic recessions, the Affordable Care Act and especially Medicaid
served as a strong safety net that helped prevent significant coverage
losses.

As we await all these major developments, I can recommend three new
Health Affairs pieces on the Affordable Care Act. The first, from
Lindsey Rose Bullinger and Angélica Meinhofer, underscores a critical
but often-overlooked provision of the law that extends Medicaid
eligibility to former foster youth

until age 26. This provision increased Medicaid coverage among former
foster youth by 3.4 percentage points. Notably though, Medicaid
expansion had an even greater impact and increased coverage by a
significant 10.1 percentage points.

The authors emphasize the role of expansion while also suggesting that
policy makers may want to revise the age extension to ensure that as
many former foster youth as possible can take advantage of this benefit.

The second article, from Joachim Hero and coauthors
,
highlights the interesting link between a person's political
orientation and their take-up of Marketplace subsidies and enrollment
under the Affordable Care Act.

And the third is my latest Eye on Health Reform column

that summarizes all the latest Affordable Care Act developments.

Looking for More?

Chris Fleming and I will be talking about these developments (and more)
at an upcoming Lunch and Learn on September 28
. Join
for the health policy as well as the chance to see my rescue dog, Kirby.
She, too, has lots of feelings about health policy and will probably
insist on adding her two cents to the conversation.

Today on Health Affairs Blog, a GrantWatch blog post by Christina
Severin and Michael Curry discusses how a consortium of federally
qualified health centers pivoted to telehealth

during the pandemic.

Rachel Sachs discusses how both the new Biden administration drug
pricing plan and the Trump administration's May 2018 blueprint diverge
in identifying policy solutions
.

Sachin Shah and coauthors claim telehealth is here to stay
,
but what it will look like, whom it will benefit, and whom it will leave
behind in the months and years ahead remains unsettled.

Katie Keith explains the coverage-related provisions under consideration
in the Build Back Better Act
.

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Your Daily Digest

The Affordable Care Act Increased Medicaid Coverage Among Former Foster
Youth

Lindsey Rose Bullinger and Angélica Meinhofer

In New England, Partisan Differences In ACA Marketplace Participation
And Potential Financial Harm

Joachim O. Hero et al.

ACA Action Continues As Law Is Upheld

Katie Keith

Telehealth Funding: Transforming Primary Care And Achieving Digital
Health Equity For Underresourced Populations

Christina Severin and Michael Curry

Biden Drug Pricing Plan Seeks To Balance Access And Innovation

Rachel Sachs

Seizing The Moment For Telehealth Policy And Equity

Sachin D. Shah et al.

Unpacking The Coverage Provisions In The House's Build Back Better Act

Katie Keith

Proposed Rule On No Surprises Act Focuses On Data Collection And
Enforcement

Katie Keith et al.

 

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