Washington Wire: August 2018

Featured Stories:

HFA, along with other patient groups, continues to argue against restrictive Medicaid eligibility policies.

HFA has written before about a new federal policy that allows states to cut off Medicaid coverage for adults who don’t meet state work requirements. The US Centers for Medicare and Medicaid Services has so far approved work requirements proposed by four states: Kentucky, Arkansas, New Hampshire, and Indiana. Seven other states have similar proposals pending with CMS. HFA and many other patient groups are concerned that the restrictive Medicaid eligibility policies encouraged by CMS threaten access to care for people with chronic health conditions.
Earlier this summer, a US District Court overturned CMS’s approval of Kentucky’s work requirements. The court faulted CMS for failing to consider whether Kentucky’s work requirements – which would end coverage for thousands of enrollees – were consistent with Medicaid’s goal of providing health care to low-income individuals. HFA submitted a letter to CMS opposing the Kentucky plan during the public comment period that ended August 18th.
Other Medicaid developments in August included:

  • Plaintiffs sued to block Arkansas from enforcing its Medicaid work requirements;
  • Nebraska officials confirmed that Medicaid expansion will be on the state ballot in November 2018 (Nebraska joins Idaho and Utah, which also have Medicaid expansion up for a vote this fall);
  • HFA signed onto comments opposing Mississippi’s revised work requirement proposal; and
  • HFA filed comments with the state of Michigan regarding its proposal to implement Medicaid eligibility restrictions and to charge premiums for Medicaid coverage.

Spotlight on protection for patients with pre-existing conditions.

Many lawmakers were rattled earlier this summer when the Trump Administration asked a federal court to overturn the ACA’s protections for patients with pre-existing conditions. With the mid-term elections approaching, lawmakers don’t want to be viewed as unsympathetic to patients. Against this backdrop, a group of ten Republican Senators introduced S. 3388 (the “Ensuring Coverage for Patients with Pre-Existing Conditions Act”) on August 23, 2018. This bill would, by its terms, require insurers to sell plans to people with pre-existing conditions and would prohibit raising premiums based on health. But the bill would also allow insurers to exclude any coverage of the pre-existing conditions. In other words, an insurer would have to sell coverage to a person with a bleeding disorder – but could exclude bleeding disorders treatment from the scope of benefits provided.
Due to that major omission, S. 3388 (like the various ACA “repeal and replace” bills from last year) would not in fact adequately protect patients with pre-existing conditions. HFA together with many other patient groups is fighting to preserve coverage for people with pre-existing conditions – the very people who most need access to health insurance. Follow and join in this effort using the hashtag #DefendPreEx.

HFA warns about new rule that seeks an expanded role for short-term insurance plans.

New rules, released Aug. 1, roll back federal limits on short-term health plans. The stated intention behind the rule is to give people additional, affordable insurance options. But short-term plans are no substitute for comprehensive insurance. Short-term plans don’t have to meet Affordable Care Act standards: they can deny coverage and/or can charge higher premiums based on health status; don’t have to cover essential health benefits such as prescription drugs; can put dollar limits on covered benefits; and don’t have to cap patient out-of-pocket spending. Short-term plans aren’t a viable option for people with bleeding disorders or other serious health conditions. Even worse, expanding access to short-term plans will draw healthy people from the risk pool, driving up premiums for everyone who still needs comprehensive insurance. You can read about HFA’s position on the final rule here, and learn about possible next steps for patient advocates. Take a look, too, at our infographic on “Short-Term Health Plans: What You Need to Know.” (While you’re at it, also check out our infographic on association health plans, the subject of an earlier federal rulemaking.)
Quick hits:

  • A federal court on Aug. 7 denied Shire’s request for a preliminary injunction against the manufacture and sale of Roche’s Hemlibra product, currently approved to treat people who have hemophilia A with inhibitors. The court’s ruling means there are no legal limitations on the ability of physicians to prescribe Hemlibra at this time.
  • More states are moving to stabilize their insurance markets via approved “reinsurance” programs. These states use federal and/or state funding to help pay some of the costs that insurers incur for covering people with expensive health needs. In recent weeks, Maine, Wisconsin, New Jersey, and Maryland obtained federal approval to implement reinsurance programs, joining Alaska, Minnesota, and Oregon. Health policy experts say that reinsurance is an effective tool to help contain premium costs for all enrollees in a state’s exchange plans.
  • CMS announced that effective January 2019, Medicare Advantage plans will be able to implement step therapy restrictions for Part B drugs (a category that includes clotting factor and other hemophilia treatments). Important details of the new policy remain unclear: for instance, the scope of the exemption from step therapy that CMS says will be available to patients who are already using a particular Part B drug. HFA is joining with other patient groups to oppose the new policy.
  • Pharmacy benefits managers (PBMs) made news in August. Express Scripts released a preliminary formulary that excludes some clotting factor products; the PBM will finalize its formulary next month. CVS Caremark announced that it would allow plan sponsors to exclude some less effective, high-cost drugs from their formularies for 2019 – but CVS Caremark stated it would keep coverage for FDA-designated breakthrough drugs.
  • The New York Times published an in-depth article on current prospects for gene therapy in hemophilia. (Have you taken HFA’s gene therapy survey?) Meanwhile, Express Scripts is reportedly in talks with manufacturers to have exclusive distribution rights for hemophilia gene therapies when they become available, perhaps as early as next year.