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The Daily Scan

Last Updated: 1:00 PM EST


  • Yesterday, the Departments of Health and Human Services, Treasury, and Labor released two final rules to provide conscience protections for Americans who have a religious or moral objection to health insurance that covers contraception methods. Under the Affordable Care Act, employer-provided health insurance plans are required to cover certain “preventative services” – which were defined through guidance by the Obama Administration as including all contraception methods approved by the FDA, including methods viewed by many as abortifacients, and sterilization procedures. In October 2017, the Trump Administration issued two interim final rules providing an exemption for those who had sincerely held religious or moral objections to such coverage, while seeking public comment on the rules. The first of yesterday's final rules provides an exemption from the contraceptive coverage mandate to entities that object to services covered by the mandate on the basis of sincerely held religious beliefs. The second final rule provides protections to nonprofit organizations and small businesses that have non-religious moral convictions opposing services covered by the mandate. The religious and moral exemptions provided by these rules also apply to institutions of education, issuers, and individuals. The Departments are not extending the moral exemption to publicly traded businesses, or either exemption to government entities. (HHS.gov, FederalRegister.gov: Final Rule on Exemptions for Religious Beliefs, Final Rule on Exemptions for Moral Convictions)

  • The Centers for Medicare & Medicaid Services (CMS) yesterday issued a proposed rule, “Patient Protection and Affordable Care Act (PPACA): Exchange Program Integrity.” This proposal would safeguard taxpayer dollars by ensuring that people are accurately determined eligible for premium subsidies they receive through the Exchange. In addition, to better align federal regulations with statutory requirements and congressional intent, the rule proposes that issuers must send a separate bill and collect separate payments for the portion of the consumer’s premium attributable to certain abortion services for which public funding is prohibited. The proposed rule would address several recommendations based on audits of both State and Federal Exchanges by the Office of Inspector General (OIG) and the Government Accountability Office (GAO) identifying substantial weaknesses in the process for determining eligibility for advance payments of the premium tax credit (APTCs) and cost-sharing reductions (CSRs). (CMS.gov, FederalRegister.gov)


  • Legal arguments over the future of voter-approved Medicaid expansion was in front of a Superior Court judge in Portland, Maine yesterday. Justice Michaela Murphy is tasked with determining whether Governor LePage’s Administration has broken the law by stalling the expansion. A lawsuit was filed in April. A day after the 2018 elections, Governor-elect Janet Mills and the Assistant Attorney General John Bolton, acting as an amicus lawyer and advisor, listened to Medicaid expansion oral arguments. One year ago, nearly 60% of Maine voters made their voices heard on Medicaid, and now the Maine Equal Justice Partners is trying to force the Governor to implement the law. Robyn Merrill, the Executive Director of the Maine Equal Justice Partners, says regardless of the support from the future governor, they are still fighting for a win in court. "We want to hold this administration accountable," said Merrill. "We want this implemented in 2018. We don’t want to wait until 2019. People were eligible for coverage as of July 2. People are waiting and over 4,500 people have applied.” Governor-elect Mills said publicly on Wednesday that her top priorities as Maine’s next governor will be expanding Medicaid as voters demanded in 2017, lowering health insurance premiums and tackling the opioid crisis that has claimed hundreds of lives. (NewsCenterMaine.com, BangorDailyNews.com)

Affordable Care Act

  • In week one of Open Enrollment for 2019, 371,676 people selected plans using the HealthCare.gov platform. Of that 367,676, 89,282 were new consumers and 282,394 were consumers renewing coverage. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, week one was only three days long this year - from Thursday, November 1 to Saturday, November 3. Every week during Open Enrollment, CMS will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges, the State Partnership Exchanges, and some State-based Exchanges. (CMS.gov)

Private Sector

  • Swiss drugmaker Novartis said it believes its new gene therapy for spinal muscular atrophy, a genetic disease affecting voluntary muscle movement, will be worth more than $4 million per dose, according to STAT. The drug in question is AVXS-101, which was proven effective in a 15-patient trial for patients with SMA, a rare genetic disorder that in its most severe form is usually fatal for patients before age 2. In the trial, infants with SMA who received AVXS-101 treatment had a 100 percent survival rate after 24 months. The trial data prompted Novartis to purchase AveXis, the gene therapy's maker, for $8.7 billion in April. If and when Novartis wins approval for AVSX-101 in the next year, the drugmaker believes it will be worth upward of $4 million, company executives said in a presentation to investors Nov. 5. However, the executives stressed that the actual price would be disclosed after receiving regulatory clearance. "Four million dollars is a significant amount of money, but we believe this is a cost-effective point," Dave Lennon, president of AveXis, told STAT. (BeckersHospitalReview.com, STATNews.com)

#Legislation #AffordableCareAct #PrivateSector #Medicaid


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