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The Weekly Scan

Last Updated: 1:00 PM EST

Medicare & Medicaid

  • The new Democratic majority in the House will hold the first hearings on Medicare-for-All legislation, a longtime goal of the party’s left, after Speaker Nancy Pelosi lent her support for the process. “It’s a huge step forward to have the speaker’s support,” said Rep. Pramila Jayapal (D-Wash.), who will be the House sponsor of the legislation, usually denoted as HR 676. “We have to push on the inside while continuing to build support for this on the outside.” Jayapal said supporters hope to release legislation in “the next couple of weeks” and hold hearings in a number of committees. (WashingtonPost.com)

  • Medicaid expansion is finally advancing in Maine, more than a year after voters approved it at the ballot box. Newly sworn in Gov. Janet Mills, a Democrat who campaigned on broadening access to health insurance, used her first executive order to direct the Maine Department of Health and Human Services to begin implementation of Medicaid expansion. The effort had been repeatedly blocked by former Gov. Paul LePage, a Republican, who cited the financial burden. He stuck with his refusal to make the change even though the state's Supreme Court ruled that the expansion's effective date was July 2, 2018. "Expanding health care and lowering the cost for Maine people and small businesses is a top priority of my administration, and I look forward to working with the legislature to achieve that goal," Mills said. The new governor also promised to work with the legislature, which is now controlled by Democrats, to make expansion financially sustainable. More than 70,000 Mainers are expected to gain coverage through expansion. (CNN.com)

  • Medicare and Medicaid underpaid U.S. hospitals by $76.8 billion in 2017, according to the latest data from the AHA's Annual Survey of Hospitals. Underpayment occurs when the payment received is less than the costs of providing care, that is, the amount paid by hospitals for the personnel, technology and other goods and services required to provide hospital care. Medicare underpayments in 2017 totaled $53.9 billion and Medicaid underpayments $22.9 billion. (AHA.org)

  • Effective January 1, Virginia's Medicaid coverage expansion went into effect, giving more adults between the ages of 19 and 64 access to quality low-cost and no-cost health insurance. Eligibility now starts at an annual income of less than $16,754 for individuals and $28,677 for families. (CoverVA.org, WSLS.com)

Affordable Care Act

  • In their first hours in control of the House of Representatives, Democrats filed a motion to intervene in an ongoing lawsuit that threatens to bring down the Affordable Care Act. The petition is signed by new House counsel Douglas Letter who wrote, "The House seeks to offer a defense addressing the same questions of law that the present parties are litigating." Notably, Donald Verrilli, who defended the law as former President Barack Obama's solicitor general and is now in private practice, is also on the brief representing the House. A federal judge in Texas last month ruled that the ACA is unconstitutional because Congress eliminated the individual mandate penalty by reducing it to $0, starting this year. This rendered the mandate itself unconstitutional and the rest of the law therefore cannot stand. The Trump administration is not defending Obamacare, so a coalition of Democratic states is appealing the judge's ruling. (CNN.com)

  • California Attorney General Xavier Becerra, leading a coalition of 17 attorneys general, yesterday filed a notice of appeal in Texas v. U.S., defending the Affordable Care Act (ACA) and the healthcare of millions of Americans. Attorney General Becerra’s filing moves his legal defense of the ACA to the Fifth Circuit Court of Appeals, where he will appeal the lower court’s ruling that the ACA is unconstitutional. “Our goal is simple: to stand up for the law of the land – the Affordable Care Act – in order to keep healthcare affordable and accessible for millions of Americans,” said Attorney General Becerra. “This shouldn’t be a debate; the ACA has been the law for nearly a decade and is the backbone of our healthcare system. This case impacts nearly every American – workers covered by employers, families, women, children, young adults, and seniors – so we will lead the ACA’s defense as long and far as it takes." (OAG.CA.gov: Press Release, Appeal)

  • CMS released final weekly enrollment data on Thursday for the 2019 Enrollment Period. There were over 8.4 million total plan selections using the Healthcare.gov platform, including more than 2 million new consumers and more than 6.3 million consumers renewing coverage. CMS will release additional data in March, including final plan selection data from State-based Exchanges that do not use the HealthCare.gov platform. (CMS.gov)


  • Last Friday, December 28, the Department of Health and Human Services (HHS) released the “Health Industry Cybersecurity Practices (HICP): Managing Threats and Protecting Patients” publication. The four volume publication, aims to provide voluntary cybersecurity practices to healthcare organizations of all types and sizes, ranging from local clinics to large hospital systems. The industry-led effort was in response to a mandate set forth by the Cybersecurity Act of 2015 Section 405(d), to develop practical cybersecurity guidelines to cost-effectively reduce cybersecurity risks for the healthcare industry. The publication marks the culmination of a two-year effort that brought together over 150 cybersecurity and healthcare experts from industry and the government under the Healthcare and Public Health (HPH) Sector Critical Infrastructure Security and Resilience Public-Private Partnership. It was the result of a true public-private partnership to better secure the nation’s health systems. (HHS.gov)

Private Sector

  • Google’s Verily, the health technology subsidiary of Google’s parent company, Alphabet, announced Thrusday that it has secured $1 billion in financing led by Silver Lake, with participation from Ontario Teachers’ Pension Plan and “other global investment management firms.” It comes two years after Verily took in $800 million of outside capital from Singapore-based Temasek Holdings. Verily CEO Andrew Conrad said the funding would be used to “support growth in key strategic areas,” including investments in strategic partnerships, business development opportunities, and potential acquisitions. “We are taking external funding to increase flexibility and optionality as we expand on our core strategic focus areas,” Conrad said in a statement. “Adding a well-rounded group of seasoned investors, led by Silver Lake, will further prepare us to execute as healthcare continues the shift towards evidence generation and value-based reimbursement models.” (VentureBeat.com, Verily.com)

  • Bristol-Myers Squibb Company and Celgene Corporation announced that they have entered into a definitive merger agreement under which Bristol-Myers Squibb will acquire Celgene in a cash and stock transaction with an equity value of approximately $74 billion. The transaction will create "a leading focused specialty biopharma company well positioned to address the needs of patients with cancer, inflammatory and immunologic disease and cardiovascular disease through high-value innovative medicines and leading scientific capabilities. With complementary areas of focus, the combined company will operate with global reach and scale, maintaining the speed and agility that is core to each company’s strategic approach." (BMS.com)

#PrivateSector #Technology #AffordableCareAct #Medicare #Medicaid


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