News for Insurers
Top stories summarized by our editors
12/18/2018

Democratic attorneys general from 17 states filed an expedited motion asking Texas District Judge Reed O'Connor, who ruled last week that the Affordable Care Act is unconstitutional, to clarify that the law should be enforced while the case is being appealed. The AGs, led by Xavier Becerra of California, also want O'Connor to certify his opinion so the case can be appealed.

Full Story:
The Hill
12/18/2018

A recent Gallup poll showed nearly 3 in 10 Americans are delaying medical treatment due to costs. People without health insurance are most likely to forgo treatment, while those covered by Medicare or Medicaid are least likely to delay health care, the poll found.

More Summaries:
Medicare
12/18/2018

Health insurers say they have the experience, perspective and data to tackle social determinants of health such as housing and transportation in Medicaid if the CMS follows through on suggestions it will fund SDOH interventions. Payers have access to members regardless of the care setting, and they are already taking steps to address beneficiaries' social risk factors.

12/18/2018

The CMS can help Medicaid managed care organizations address social determinants of health by implementing policies that make it easier for at-risk populations to access health care services and foster interagency coordination on SDOH programs, according to the Association for Community Affiliated Plans. Also needed are additional guidelines on how states can encourage MCOs to invest in SDOH programs, approval of more demonstrations that test interventions and support for outcomes-based payments in this area, the report indicates.

Full Story:
FierceHealthcare
12/18/2018

Anita Cattrell, Evolent Health's chief innovation officer, discusses how health care organizations, caregivers and communities can overcome challenges in addressing social determinants of health, citing examples from Evolent's collaboration with Passport Health and other Medicaid plans. These challenges include identifying patients at risk of adverse health events due to social barriers, integrating social therapies with clinical care and creating the social equivalent of clinical decision support.

Full Story:
Health Affairs Blog
12/18/2018

Sen. Elizabeth Warren, D-Mass., is proposing the Affordable Drug Manufacturing Act to increase the availability of generic drugs that meet standards for market failure. Other Democratic senators as well as Bernie Sanders, I-Vt., have introduced legislation aimed at reducing drug prices.

Full Story:
Politico
12/18/2018

Sen. Cory Booker, D-N.J., says he will propose legislation that would require drugmakers to disclose financial relationships with state Medicaid drug board members, including pharmacists.

Full Story:
National Public Radio
More Summaries:
Sen. Cory Booker
12/18/2018

A bill introduced by Sens. Orrin Hatch, R-Utah, and Thom Tillis, R-N.C., and Rep. William Flores, R-Texas, would restrict generic-drug makers' right to use inter partes patent reviews to challenge brand-name drugmakers' patents.

12/18/2018

CMS Administrator Seema Verma said she will set up an office for reducing "regulatory burden" on patients and health care providers.

12/18/2018

Novartis held a media briefing ahead of a forthcoming report from the Institute for Clinical and Economic Review on the cost-effectiveness of Zolgensma, a gene therapy for a rare genetic disease, that Novartis says would be cost-effective at $4 million to $5 million.