GOP Health Reform

Another 3,815 Medicaid beneficiaries in Arkansas will be kicked off the program for failing to meet the state’s new work requirements, bringing the total to more than 12,000 people who have lost coverage since the work requirements kicked in this summer.

CMS Administrator Seema Verma said Wednesday (Nov. 14) the administration is committed to giving drug plans more leverage to negotiate lower prices for drugs in protected classes.

In the wake of leadership elections, newly re-elected Senate Minority Leader Chuck Schumer (D-NY) told reporters that his caucus plans to continue its focus on healthcare in the 116th Congress by using the Democratic majority in the House to press Senate Republicans to take up Democratic health legislation.

House Republicans may not have time during the lame-duck period to revisit a package of bills that would provide employers retroactive relief from a series of Affordable Care Act taxes, but Republicans still hope an end-of-year package in the House could offer relief from some employer taxes, outgoing Ways & Means Committee Chairman Kevin Brady (R-TX) said.

Express Scripts is introducing an optional formulary for drugs with alternative drug codes, which starts the move from so-called spread pricing based on rebates to a system that shares those rebates at the pharmacy counter, the pharmacy benefit manager announced Tuesday (Nov. 13).

Dozens of academics in public health and health law told a federal judge that CMS misrepresented studies on the relationship between work and health when the agency approved Arkansas’ controversial program of Medicaid work requirements.

While stakeholders expect lawmakers to focus less on Medicare than other health policy in the new Congress, strengthening Medicare is still part of Rep. Frank Pallone's (D-NJ) agenda for the House Energy & Commerce Committee, advocates hope Democrats will look at coverage gaps in the program, and lobbyists say lawmakers could take another look at the site-neutral cuts included in CMS’ recent hospital pay rule.

A federal judge has temporarily shut down a Florida-based operation that the Federal Trade Commission charged with misleading consumers into thinking they were purchasing comprehensive, ACA-compliant coverage, rather than skimpy products that left them with unpaid medical claims and thousands in bills.

HHS Secretary Alex Azar on Thursday (Nov. 8) said CMS plans to both bring back the mandatory bundled-pay models the agency canceled last year and look at new models, including for radiation oncology.