September 16, 2021 | Who pays for mandated workplace testing?

INDUSTRY NEWS

Despite economy, uninsured rate steady

The uninsured rate remained at 11% from March 2019 to April 2021, largely due to a freeze in Medicaid disenrollment and increased ACA subsidies, according to an Urban Institute report. This is atypical for economic downturns. Just over 37% of adults with low incomes in non-expansion states were uninsured in 2021, compared with 14.5% in expansion states. Researchers say maintaining the current rate will require protecting coverage for current and prospective Medicaid enrollees as the economy improves and the disenrollment freeze is lifted. (Healthcare Dive; report)

Who pays for mandated workplace testing?

The Biden administration is mandating that workers at large companies get vaccinated, or submit to regular testing. But who will pay for the testing? It largely depends on the employer, the New York Times reports. Federal law requires insurers to fully cover the tests ordered by a health care provider, but routine workplace tests are exempt. (New York Times)

INNOVATION & TRANSFORMATION

HHS includes value-based model in prescription drug plan

Last week, HHS released its 29-page roadmap for cutting prescription drug costs. Making headlines is the fact it would allow Medicare to negotiate prices. But behind the headlines is another very important provision: The CMS Innovation Center would be authorized to create small-scale mandatory models that link payments for drugs and biologics to metrics of clinical value to the patient—specifically, “improved patient outcomes, reductions in healthcare disparities, patient affordability and lower overall costs.” (Becker’s Hospital Review; Fierce Healthcare; HHS announcement and link to plan)

Leaders: Create federal council to coordinate primary care

In a NEJM Perspective piece, members of the Primary Care Centers Roundtable call for a government entity responsible for a national primary care strategy. It wouldn’t solve the problem facing primary care, “but without such a concerted effort, the most important infrastructure available for advancing health equity will continue to erode.” Such an initiative “should include oversight, tools, and resources for rebuilding primary care, with clear accountability vested in a single council and an overarching goal of achieving health equity.” (NEJM*)

CONSUMERS & PROVIDERS

No Surprises Act: Providers, payors want more time

Citing the ongoing pandemic and a lack of information, payors and hospitals say they need more time to comply with the No Surprises Act, which bans balance billing. Payers are asking for a safe harbor until 2023. Safety net hospitals represented by America's Essential Hospitals want implementation delayed until six months after the COVID-19 public health emergency ends. The American Hospital Association and AHIP called for a multi-stakeholder group. They're especially concerned about the non-consumer-facing aspects of the ban, including arbitration. (Modern Healthcare*; Healthcare Dive)

ACA exchanges see increased competition

Next year may be the most competitive yet on the ACA insurance exchanges. At least 11 insurers plan to enter new markets and some current ones are expanding their presence, Modern Healthcare reports. "There's increased and enhanced competition in a variety of markets nationally, as more and more players look to enter and to be more aggressive in the space," says Ari Gottlieb, a principal at the consultancy A2 Strategy. He adds that increased competition generally results in lower premiums, but there are many other factors at play. (Modern Healthcare*)

NEW & NOTED

Even more children: More than a fourth of the roughly 1 million new weekly COVID-19 cases involve children, according to the American Academy of Pediatrics. It’s the highest point for the pandemic. (AAP)

More scrutiny, but will it matter? Analysts expect the Biden administration to take a stricter approach to competition in health care, including increased scrutiny of mergers and efforts to promote transparency, Morning Consult reports. However, they warn that consolidation between health care providers and insurers will be difficult to control. (Morning Consult)

Relationship issues: A proposed rule announced last week would require marketplace and short-term, limited-duration plans to disclose whether they have a financial relationship with an agent or broker and how much they paid that agent or broker. It also spells out how CMS would determine whether states are enforcing the new surprise-billing ban for air ambulance transport. (Modern Healthcare*; proposed rule)

MULTI-MEDIA

Disenfranchised grief: Politicization of the pandemic is making it hard to grieve, creating a stigma around COVID-19 deaths. This leads to something called "disenfranchised grief.” Mourners feel they don't have the right to fully grieve because of controversy over the cause of death. (NPR)

MARKETVOICES…QUOTES WORTH READING

“High-quality primary care is vital but undersupported in the United States. […] Despite efforts to strengthen the U.S. primary care infrastructure, the situation is worsening.”—Kevin Grumbach, MD; Thomas Bodenheimer, MD, MPH; Deborah Cohen, PhD; Robert L. Phillips, MD, MSPH; Kurt C. Stange, MD, PhD; and John M. Westfall, MD, MPH, in a NEJM Perspective* piece