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Upcoming Delegate Council MeetingWhat a great Delegate Council Meeting we had last month. Great food, stimulating conversation, gorgeous venue, and amazing colleagues. Please join us for our next Delegate Council meeting on August 18th from 6-8 p.m.
For details please contact Connor Hinton: chinton@kcmsociety.org
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Health Care Mergers
James Paribello, KCMS lobbyist
The White House’s statement on Biden’s Executive Order regarding Health Care, with special attention given to mergers in the industry can be found here: Link to Executive Order Statement Biden's recent Executive Order focuses, in part, on hospital consolidation, and calls for the Federal Trade Commission (FTC) to review past mergers to see if those have brought harm to patients. The FTC is an independent agency of the US government whose principal mission is the enforcement of antitrust law and the promotion of consumer protection.The White House says, "Thanks to unchecked mergers, the ten largest healthcare systems now control a quarter of the market... Research shows that hospitals in consolidated markets charge far higher prices than hospitals in markets with several competitors." Biden is making market competition and anti-trust regulation a central focus of his administration, and hospitals are getting wrapped up in that review.
White House Statement on Executive Order: Healthcare The proposed Order tackles four areas where lack of competition in healthcare increases prices and reduces access to quality care.
I. Prescription Drugs: Americans pay more than 2.5 times as much for the same prescription drugs as peer countries, and sometimes much more. Price increases continue to far surpass inflation. As a result, nearly one in four Americans report difficulties paying for medication and nearly one in three Americans report not taking their medications as prescribed.
These high prices are in part the result of a lack of competition among drug manufacturers. The largest pharmaceutical companies are able to wield their market power to reap average annual profits of 15-20%, as compared to average annual profits of 4-9% for the largest non-drug companies.
One strategy that drug manufacturers have used to avoid competing is “pay for delay” agreements, in which brand-name drug manufacturers pay generic manufacturers to stay out of the market. That has raised drug prices by $3.5 billion per year, and research also shows that “pay for delay” and similar deals between generic and brand name manufacturers reduce innovation—reducing new drug trials and R&D expenditures.
In the Order, the President:
- Directs the Food and Drug Administration to work with states and tribes to safely import prescription drugs from Canada, pursuant to the Medicare Modernization Act of 2003.
- Directs the Health and Human Services Administration (HHS) to increase support for generic and biosimilar drugs, which provide low-cost options for patients.
- Directs HHS to issue a comprehensive plan within 45 days to combat high prescription drug prices and price gouging.
- Encourages the FTC to ban “pay for delay” and similar agreements by rule.
II. Hearing Aids: Hearing aids are so expensive that only 14% of the approximately 48 million Americans with hearing loss use them. On average, they cost more than $5,000 per pair, and those costs are often not covered by health insurance. A major driver of the expense is that consumers must get them from a doctor or a specialist, even though experts agree that medical evaluation is not necessary. Rather, this requirement serves only as red tape and a barrier to more companies selling hearing aids. The four largest hearing aid manufacturers now control 84% of the market.
In 2017, Congress passed a bipartisan proposal to allow hearing aids to be sold over the counter. However, the Trump Administration Food and Drug Administration failed to issue the necessary rules that would actually allow hearing aids to be sold over the counter, leaving millions of Americans without low-cost options.
In the Order, the President:
- Directs HHS to consider issuing proposed rules within 120 days for allowing hearing aids to be sold over the counter.
III. Hospitals: Hospital consolidation has left many areas, especially rural communities, without good options for convenient and affordable healthcare services. Thanks to unchecked mergers, the ten largest healthcare systems now control a quarter of the market. Since 2010, 138 rural hospitals have shuttered, including a high of 19 last year, in the middle of a healthcare crisis. Research shows that hospitals in consolidated markets charge far higher prices than hospitals in markets with several competitors.
In the Order, the President:
- Underscores that hospital mergers can be harmful to patients and encourages the Justice Department and FTC to review and revise their merger guidelines to ensure patients are not harmed by such mergers.
- Directs HHS to support existing hospital price transparency rules and to finish implementing bipartisan federal legislation to address surprise hospital billing.
IV. Health Insurance: Consolidation in the health insurance industry has meant that many consumers have little choice when it comes to selecting insurers. And even when there is some choice, comparison shopping is hard because plans offered on the exchanges are complicated—with different services covered or different deductibles.
In the Order, the President:
- Directs HHS to standardize plan options in the National Health Insurance Marketplace so people can comparison shop more easily.
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Are you a physician on the move?Let us know what you are up to! We'd love to share your news.
Email Connor Hinton at: chinton@kcmsociety.org
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COVID-19 Update - Pfizer BoosterClick here for updates on the COVID-19 pandemic and the new information from Pfizer on the possible rollout of their new booster for the Delta variant.
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Apple Health and the Public Health Emergency
The Health Care Authority (HCA) learned from the Department of Health and Human Services (HHS) that the current COVID-19 public health emergency (PHE) has been extended through October 18, 2021. According to HHS’ letter to the Governors, the PHE may be extended through the rest of 2021 in 90-day increments. HCA will have 60 days-notice before the emergency ends and will communicate to clients, partners, and stakeholders before any eligibility changes take place.
What does this mean for Apple Health clients?
Current Washington Apple Health (Medicaid) clients will not lose their coverage during the PHE unless they do not meet residency, citizenship, or immigration requirements, or request closure. Clients should continue to report changes, including changes to their household contact information.
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