Biden pitches a new Obamacare enrollment plan — State groups push for more ACA support — White House readies order aimed at corporate giant

From: POLITICO Pulse - Tuesday Jun 29,2021 02:08 pm

Jun 29, 2021

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With Rachel Roubein

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On Tap

— Biden’s new Obamacare proposal aims to bolster the law, increase enrollment and roll back Trump-era policies.

— But state health plans are pushing for more ACA support from Congress in the next relief package.

— Biden’s potential order on corporate mergers could throw new scrutiny on health care deals.

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Driving the day

BIDEN LOOKS TO PUT HIS STAMP ON OBAMACARE’S MARKETPLACE — The Biden administration is pitching new plans for boosting Obamacare enrollment and gutting Trump-era policies under a new proposal aimed at bolstering the health care law, Rachel Roubein writes.

The administration is looking to extend Obamacare’s annual enrollment season by one month starting this fall, and to allow some of the poorest marketplace customers to buy coverage essentially whenever they want. Specifically, CMS plans to eliminate the strict sign-up window for Americans who earn under 150 percent of the federal poverty level. Instead, those consumers, who receive generous financial help, would be allowed to sign up each month.

Biden is also continuing efforts to roll back Trump-era rules that Democrats argued would have undermined the marketplaces.

— CMS wants to pull back a policy, approved in the previous administration’s final days, that would have allowed states to eliminate their marketplaces and turn enrollment entirely over to private web brokers and agents.

— The Biden administration is also proposing to rescind a Trump policy that relaxed many of Obamacare’s strict guardrails for approving states’ marketplace changes through the Obamacare waiver program. And CMS will roll back another Trump policy requiring insurers to send a separate monthly bill to cover abortion-related services.

Biden has staked his health care agenda on bolstering the Affordable Care Act, and the rescue plan passed in March gave the biggest boost to Obamacare since its passage in 2010. But it’s a far cry from the calls for universal coverage from the Democratic party’s progressive wing.

STATE HEALTH GROUPS: SPENDING PACKAGES SHOULD SHORE UP ACA — A coalition of state health advocacy organizations is urging Biden to build out Obamacare as part of his next spending bills, laying out a range of policy options in a letter to the White House and congressional leaders.

The proposal, signed by groups spanning more than a dozen states, argues that Congress should crib from state-level ideas aimed at expanding and improving coverage. “We have highlighted examples from these states that can serve as models in health policy innovation as federal policymakers consider future reforms,” they wrote.

Among the options: Fully funding navigator programs that help people sign up for coverage, streamlining the enrollment process and making permanent more generous subsidies for a greater proportion of Americans.

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WHITE HOUSE READIES ORDER AIMED AT CORPORATE GIANTS — The Biden administration is crafting a policy trained at massive companies it argues are strangling competition across industries, three people familiar with the discussion tell our Leah Nylen.

A crackdown could easily emanate to health care giants. The order, which could be issued as soon as this week, calls on the U.S.’ two antitrust agencies, the Justice Department and the Federal Trade Commission, to update guidance on how they examine proposed corporate mergers. Those include so-called vertical mergers that have typically attracted only light attention from regulators — such as CVS Pharmacy’s acquisition of health insurer Aetna.

The order would also mark a big shift in the government’s approach to the concerns about monopolies that have swelled during the 21st century: No longer content to just enforce antitrust laws, the Biden administration would use federal power to actively spark competition in a vast array of businesses, Leah writes.

The order isn’t final and hasn’t yet been presented to Biden, the three people familiar said. The White House said Monday that the president has made no decisions about signing such an order.

“The President made clear during his campaign that he is committed to increasing competition in the American economy, including by banning noncompete agreements for workers and protecting farmers from abusive practices, but there is no final decision on any actions at this time,” White House spokesperson Emilie Simons said.

CMS PITCHES EXPANDING VALUE-BASED PAYMENT FOR HOME HEALTH AGENCIES — The agency wants to pay home health agencies for the quality of care they provide, instead of the quantity of services delivered. In a new rule released Monday, CMS proposed expanding its Innovation Center’s value-based purchasing model — which previously operated in nine states — nationwide effective Jan. 1, 2022.

Drug Pricing

ALZHEIMER’S DRUG DEBATE CONTINUES — FDA officials were alarmed by the “inconsistency” of data in a late-stage trial for Biogen’s Aduhelm, the $56,000-a-year Alzheimer’s drug, according to documents released by the agency on Monday. This skepticism was reflected in a slew of correspondence the agency made public last week, adding to the disputed opinions around the drug, Katherine Foley writes.

It is the latest knock for the new medicine, the first Alzheimer’s drug approved in nearly two decades. Two House committees late last week launched a joint investigation into the decisions behind the new Alzheimer’s drug’s approval and sticker price.

Analysts are on guard, but not overly concerned. “Obviously any investigation and/or hearing involves potential risks including bad performance at a hearing or a "smoking" gun email,” Cowen analyst Rick Weissenstein wrote in an email to investors. Hearings also could be an opportunity for critics of acting FDA Commissioner Janet Woodcock to question her leadership. But a hearing could also give Biogen and Alzheimer’s advocates a chance to advocate for the therapy, Weissenstein said.

FIRST IN PULSE : DRUG PRICING GROUP REPORT ON INDUSTRY TIES TO PATIENT ADVOCACY GROUPS — Patients for Affordable Drugs Now, a progressive group pushing for significant drug-pricing reforms, released a report today documenting the pharmaceutical industry’s influence on patient advocacy groups and charitable groups like the American Cancer Society and the Patient Advocate Foundation.

The details: The report digs into the tax filings, financial statements, annual reports and other records of more than a dozen prominent patient advocacy groups. P4AD argues that these ties — which have long existed in the patient group universe — are directly related to the groups’ across-the-board decision not to back House Democrats’ sweeping drug price negotiation bill.

“Patients, policymakers, and media need to know when they hear from a patient group on a policy issue that funding from drug companies may affect the positions the organization takes,” argued P4AD’s founder David Mitchell.

Names in the News

Daniel Tsai joined CMS as the Director for Medicaid and CHIP Services. Tsai most recently served as Massachusetts’ Assistant Secretary for MassHealth and Medicaid Director, where he led the program through restructuring aimed at a shift towards value-based care.

He will lead Medicaid and CHIP programs’ efforts to address disparities, CMS said in a statement.

Michael Pratt, the HHS spokesperson for Operation Warp Speed during the Trump administration, joined Real Chemistry as a Senior Group Director for Strategic Policy, Advocacy, and Government Communications.

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What We're Reading

Aduhelm maker Biogen and the FDA backchanneled extensively — including undisclosed meetings and collaboration over the drug’s route to market — over several years of research starts and setbacks, Stat News’ Damian Garde, Adam Feuerstein and Matthew Herper report in an in-depth exploration of the medicine’s development journey.

Oregon’s state legislature approved a bill that would require regulators to sign off on any health care mergers and deals that would increase a group’s net patient revenue by $1 million or more, Modern Healthcare reports.

Juul agreed to pay $40 million in a settlement with North Carolina over teen vaping, the first resolution in a stream of lawsuits against the e-cigarette giant, New York Times' Sheila Kaplan writes.

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UnitedHealth Group believes that all individuals should have access to high-quality, affordable health care that meets their unique needs. We are committed to advancing health equity by delivering personalized care, building a diverse health workforce, improving the health of underserved communities and providing insights and analyses to address disparities in care. Learn more about our commitment to sustainability in our recently released 2020 Sustainability Report.