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Celebrating 35 years of making Medicare more accessible, affordable, and equitable!

Julie Carter

Senior Federal Policy Associate

Shifting Drugs from Part B to Part D May Create Winners and Losers

This week, Avalere Health, a Washington DC-based consulting firm that specializes in strategy, policy, and data analysis, released a study on the impact of moving the coverage of some drugs from Medicare Part B to Part D. While most drugs are covered under the Part D prescription drug program, Part B, the part of the Medicare program that covers outpatient medical services like office visits, covers a few. The drugs covered by Part B are usually ones that beneficiaries would not give to themselves. For example, if a provider administers the drug during an office visit, Part B instead of Part D, might cover that drug.

Earlier this month, the Trump Administration announced it would consider transitioning certain Part B drugs into Part D as part of a larger strategy to lower drug prices and out-of-pocket costs. This makes it essential to understand what effects the switch could have on people with Medicare.

New Drug Spending Tool May be Helpful for Researchers and Policymakers—Not Much Help for Consumers

This week, the Centers for Medicare & Medicaid Services (CMS) released new data and a new tool on prescription medication: the Drug Spending Dashboard. The Dashboard allows users to see list prices of various medications, how many manufacturers supply the drug, what they have been paid by Medicare—both Part B and Part D—and Medicaid, total and per beneficiary spending on the drug, and comparisons of spending from 2015 to 2016. Such data show trends in both drug pricing and program spending, and CMS offers additional data for use outside of the Dashboard.

Health Care Legislation Cropping Up in Unexpected Places

This week, several health care programs appeared in legislation that does not normally address health care. Two of the surprise provisions are embedded in draft Farm Bill legislation and in cuts, or rescissions, requested by the White House. While these measures may gain traction in the U.S. House of Representatives, they face a more uncertain future in the Senate.

Millions Lose Coverage as Affordable Care Act Changes Take Effect

This week, the Commonwealth Fund’s Affordable Care Act Tracking Survey showed recent coverage declines among 19-to-64-year-olds. The survey’s focus is on adults who gained coverage through the ACA’s marketplaces and Medicaid.

The findings show that an estimated four million people have lost coverage since 2016. Significant changes can be seen for lower income households and people aged 35-49, and the losses are even more pronounced in states that have not expanded Medicaid—especially southern states—and among people who self-identify as Republican. For example, among Republicans surveyed, the uninsured rate has risen from 7.9% in 2016 to 13.9% in 2018, with self-identified Democrats seeing no change.

Improving Medicare Plan Finder Should be a Priority

This week, the National Council on Aging (NCOA) and the Council for Affordable Health Coverage’s Clear Choices Campaign released a long-anticipated report on the Medicare Plan Finder (MPF) tool. The Modernizing Medicare Plan Finder Report highlights some of the issues Medicare beneficiaries, their families, and their caregivers encounter while using the MPF tool as well as future considerations for the tool’s development and recommendations for improvement.

Lawsuit Alleges Kentucky Medicaid Work Requirement Breaks Federal Law

On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance announcing a new policy that, for the first time, will allow states to make participation in a work or “community engagement” program a condition for Medicaid enrollment. The next day, CMS approved a Medicaid waiver in Kentucky that will allow the state to test this new policy.

Medicare Rights Continues to Review New Medicare Rules and Guidance

Over the past few months, the Medicare Rights Center has been actively engaged in considering and commenting on proposals from the Centers for Medicare & Medicaid Services (CMS) that could have significant effects on people who are enrolled in Medicare Advantage (MA) and Part D plans. Last week, CMS released both the Contract Year 2019 Final Rules for Medicare Advantage and Part D (Final Rules) and the 2019 Call Letter. CMS also released fact sheets for the Final Rule and the Call Letter. As we continue to analyze the Final Rules and Call Letter, as well as the impact of the recent two-year budget deal, here is a preview of the issue areas we intend to spotlight, which focus on regulatory trends, anticipated implementations, and practical changes that will impact people with Medicare and those who help them navigate coverage decisions.

Providers Are Key to Controlling Unnecessary Health Care Spending

Health care in the United States is very expensive, and many experts believe one thing contributing to that expense is the abundance of unnecessary or “low-value” health care services provided to patients. Policymakers typically believe that patients receive this unnecessary care because they expect or demand it. However, this month, the University of Michigan revealed new polling data that turns that assumption upside down.

People with Medicare Burdened with Higher Health Care Spending

The Kaiser Family Foundation recently released a report with new data on how much people with Medicare paid for health care in 2016 as a share of their total spending. These data show that Medicare households spend a higher proportion of their incomes on health care coverage, services, and drugs than non-Medicare households. This is important information when discussing what policies should be enacted to protect or improve Medicare’s affordability, especially for those with tight household budgets and fixed incomes.

The Numbers Are In: Undermining the ACA Will Hurt Health Coverage and Increase Costs

Last week, Medicare Rights explored some of the looming risks to health coverage and affordability created by recent administrative efforts to undercut the Affordable Care Act (ACA). As we noted then, the Trump administration has proposed several new rules that would allow insurers to offer coverage that does not meet the standards set by the ACA. In addition, Congress has taken steps to undermine the ACA’s coverage by repealing the individual mandate in last year’s tax bill, despite evidence that doing so would cause millions to lose coverage. Together, these changes threaten to undermine the design and achievements of the ACA. Now the Urban Institute, a nonpartisan research organization, and Avalere, a nonpartisan health consulting firm, have released studies that add concrete numbers to these risks.

CELEBRATING

YEARS

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