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House Speaker Nancy Pelosi’s (D–Calif.) long-anticipated drug pricing plan — the Lower Drug Costs Now Act of 2019 (H.R. 3) — has shaken up the drug pricing debate. It gives Medicare the ability to negotiate drug prices, further fueling the partisan divide between Democrats and Republicans, but also includes policies similar to those championed by Senate Finance Committee Chair Chuck Grassley (R–Iowa), such as caps on price increases in Medicare Parts B and D, as well as changes to the Part D benefit design. The way the bill approaches drug price negotiation is similar to the Trump administration’s supposedly soon-to-be-released international price index (IPI) proposal, which has been under review at the Office of Management and Budget since.
The Affordable Care Act’s insurance reforms aimed to create a set of favorable market conditions to help the small-group and individual markets perform more like the well-functioning large-group market. Thus one way to measure the effectiveness of the ACA’s reforms is to observe the extent to which these market segments have converged in terms of profitability and premiums or have continued to differ on such measures. In this post, we consider whether the three market segments report similar — or substantially different — financial performance during the first four years of the ACA.
The goal of universal coverage depends on moderating health care costs, which will require overcoming the unjustified variation and inflationary rise in the prices of care, including drug prices. To gain insight into these challenges — and opportunities — it may be instructive to look at pharmaceutical assessment and pricing in Germany. Germany’s health insurance system shares many characteristics with that of the United States, yet the country has lower drug prices, as well as prices that are more directly linked to clinical benefit.
Congress and the Trump administration have considered a range of actions to lower prescription drug prices, but there is one that’s flown under the radar of most policymakers: binding arbitration. At a recent Capitol Hill briefing held by the National Coalition on Health Care — a group of diverse stakeholders seeking a health system that is “more effective, efficient and responsive” — a panel of experts discussed the potential of this option to help determine prices for selected high-cost drugs covered under Medicare Part D.
Under the Trump administration, short-term, limited-duration health plans, formerly limited to a three-month duration, can be held for up to nearly one year and renewed for up to three years. The flaws of short-term plans — no requirement to cover essential health benefits, annual limits, preexisting conditions exclusions, and excessive cost-sharing — have been well-documented. But another problem with these health plans is that they do not offer a network of health providers, which leads to unexpected “balance bills” for the consumer.
People who qualify for both Medicare and Medicaid — known as dual-eligible beneficiaries — frequently have complex and costly health care needs. Since 2011, the federal Centers for Medicare and Medicaid Services (CMS) has collaborated with 13 states to integrate benefits for this low-income population through a demonstration called the Financial Alignment Initiative.
The midterm election of Democratic governors in states like Kansas, along with three successful Medicaid expansion ballot initiatives, laid the groundwork for the first serious expansion debates in a number of states. Yet, when combined with recent court rulings striking down Medicaid work-requirement programs in Kentucky and Arkansas, and an administration intent on reforming the program created to serve the nation’s most vulnerable people, a perfect storm of uncertainty has been created.
The Trump administration released guidance last week that is good news for people with chronic conditions. Starting in 2020, Medicare Advantage plans — private health plans that contract with Medicare — will be allowed, but not required, to offer chronically ill enrollees nonmedical services for social needs that affect health. This is an important step for Medicare. Many older Americans, particularly those who are very sick, will greatly benefit given their high levels of unmet social needs.

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