This is NOT Business As Usual

In a stunning move, the Department of Justice has submitted a brief memo to the 5th Circuit Court of Appeals stating that they believe the entirety of the Affordable Care Act should be overturned. This is an even more draconian view than the Texas vs Azar case.

No one, at least in the health policy and legal world, on either side, has indicated that the Texas case has any real legal standing, but the 5th Circuit Court of Appeals is the most conservative court in the US, and this could now go to the Supreme Court - again.

Michigan law professor Nicholas Bagley tries to break it all down in a recent blog post, in which he calls the move “a serious threat to the rule of law.”.

Survey Says...

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Our Ask: This is not a legislative request. Rather, we are asking for your help with two subjects being discussed with the Maryland Health Benefit Exchange (MHBE) Affordability and State Benchmark Plan Workgroups. 

What and Why: These workgroups - Affordability and State Benchmark Plan (SBP) - will develop recommendations for the Board of Trustees on these two issues. CHF is participating on both workgroups, with President, Beth Sammis serving as Affordability Co-Chair, and Board Member, Leni Preston as SBP Chair.

We Need You: Specifically, we need YOUR expertise as we develop those recommendations. The last meeting of the workgroups will be held in early May and before then we will be meeting to provide recommendations on:

  • How to increase affordability of Qualified Health Plans for consumers both inside and outside the Exchange.

  • Whether the current State Benchmark Plan meets consumers' needs, and if Maryland should leverage federal regulations that allow for greater state flexibility on the design of the SBP and what the timing might be.

For complete information on all workgroups go here.

Here's How To Help:  All we ask is that you take just 10 minutes (really!) to fill out a short survey.  The deadline is Tuesday, March 26, but go ahead - do it now, and thanks for your input!


The President's Budget Proposal: Bad for the Health of America

On Monday, President Trump sent to Congress his  "A Budget for a Better America" with the subtitle "Promises Kept. Taxpayers First." Not only does it not adhere to his promise that no changes would be made to Medicaid or Medicare, but it clearly doesn't align with our concept of health care for all. In fact, the proposals would reverse the progress we have made in spite of the Administration's "death by a thousand cuts" approach.

Here are the highlights:

  • $845 billion dollars cut from Medicare over the next 10 years just as baby boomers start to flood the program.

  • $245 billion cut from Medicaid over the next 10 years to "shift more power to the states."

  • A nationwide work requirement for Medicaid.

  • The elimination of "zero premium" ACA plans.

  • 12% decrease in funding to the NIH, amounting to about $4.5 billion.

  • 10% decrease in funding to the CDC, despite a year in which outbreaks of measles, whooping cough, flu, and other diseases normally protected by vaccines, are on the rise.

Add to this the cuts made to the EPA and its environmental health programs, as well as global health programs, humanitarian aid, and more. Taken together, this becomes an all out assault on the health and well being not only of Americans, but our friends around the world. 

See where your elected officials stand:

  • Congressman Andy Harris of the 1st District has not issued a statement, however, here is what others in Maryland's Congressional Delegation are saying: 

See what the media and others are saying: 

Maryland Total Cost of Care Model - Transforming Health and Health Care

In this week’s issue of the JAMA Network, Maryland’s Total Cost of Care Model is described and highlighted as a positive and successful demonstration of how a CMS Innovation Center partnership with a state can accelerate transformation across payers and generate significant savings. Maryland has made a commitment by taking total-cost-of-care accountability for all Maryland Medicare fee-for-service beneficiaries. The Maryland total-cost-of-care model will test new ways to reduce costs and improve quality across the health care continuum with an emphasis on population health. None of this is possible without a strong federal-state partnership. Together, CMS and the state are implementing a model that aligns financial incentives across an increasing number of Maryland clinicians, facilities, and suppliers and offers them new tools to help achieve better health and lower costs for the populations they serve.

Consumer Health First looks forward to continuing to promote the consumer perspective in the model on HSCRC's work groups.

Supreme Court Refuses to Take up Maryland Law on Pharmaceutical Price Gouging

On Tuesday, the Supreme Court of the United States let stand a ruling from the 4th U.S. Circuit Court of Appeals . The law was the first of its kind in the nation, although other states have considered similar measures.

The law applied to generic or off-patent drugs manufactured by at least three other firms. It would prevent those companies from imposing a significant price increase without justifying it to the attorney general, who could then ask a judge to order that the price increase not take effect. Violating the law carried a $10,000 fine.

The appeals court held the measure violated the U.S. Constitution by trying to regulate trade outside of Maryland.

This is a blow to consumers and efforts to achieve drug pricing transparency.

Consumer Health First is supporting current legislation efforts to create a Prescription Drug Affordability Board, which would protect State residents and certain stakeholders within the health care system from the high costs of prescription drug products, by requiring certain conflicts of interest to be considered when appointing Board members, and requiring the Board to identify certain prescription drug products with certain costs. It would also establish a Prescription Drug Affordability Stakeholder Council.

Get the Latest Data on Medicaid Benefit Coverage for Adults in Each State, including Behavioral Health Services

Federal Medicaid rules grant states flexibility to design their own benefit packages beyond meeting core federal requirements. The Kaiser Family Foundation recently surveyed Medicaid directors in all 50 states and the District of Columbia to identify those benefits covered for categorically needy traditional adult beneficiaries in their fee-for-service programs. Their updated Medicaid Benefits Database includes data about the various benefits covered in states, notable limits on those benefits, and cost sharing requirements as of July 1, 2018. Data from previous years (generally 2012 and earlier) is also accessible. Also available for the first time is another database that includes data on Medicaid coverage of a range of behavioral health services, by state, at KFF’s Medicaid Behavioral Health Services Database.

The databases should be useful for Medicaid officials, researchers, patient advocates and journalists trying to understand the variation across states in Medicaid benefits such as dental coverage, private duty nursing services and treatment for opioid addiction.