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: arecent 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 ruleon 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 toAugust 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.
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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