Medicare

The White House Council of Economic Advisers links single-payer healthcare to what it calls the pitfalls of socialism, arguing in a new report that socialism is making a comeback in American politics and that Medicare-for-all would hurt seniors and cause the Gross Domestic Product to fall.

American Medical Association President Barbara McAneny on Tuesday (Oct. 16) expressed hope that CMS will test doctors' proposals recommended by the Physician-Focused Payment Model Technical Advisory Committee, but the head of the Health Care Transformation Task Force said it is unlikely a perfect model will walk in the door and P-TAC needs to be given authority to advise CMS on which proposals to test.

American Medical Association President Barbara McAneny on Tuesday (Oct. 16) raised concerns with a single-payer system based on Medicare, as well as a Medicaid buy-in being pursued in New Mexico, and said that moving people from commercial coverage to government-funded health care programs could cause practices to close, especially in rural areas, due to inadequate reimbursement.

CMS Administrator Seema Verma on Tuesday (Oct. 16) lamented CMS' lack of adequate legal authority to conduct Medicare prior authorization reviews that are routine in the private sector, coming as American Medical Association President Barbara McAneny told reporters that prior authorization can cause major disruptions to care and contributes to providers' administrative burden.

The standard monthly premium for Part B beneficiaries will increase slightly for 2019, but about 2 million beneficiaries will pay less than the full premium due to the statutory hold-harmless provision, according to CMS.

Patient advocates plan to meet with HHS officials in the coming weeks to make their case against what they say is an increasingly common insurance industry practice of preventing drug company financial assistance from counting toward consumers’ deductibles and out-of-pocket spending limits.

Industry lawyers say it is not clear whether Congress' expansion of the sunshine law's reporting requirements to include industry payments to health professionals beyond doctors will kick in in 2021 or 2022.

The Justice Department on Wednesday (Oct. 10) approved the $69 billion merger of CVS Health Corporation and Aetna, two of the largest companies in the prescription drug market, but Aetna must sell its Medicare Part D plans that cover 1.5 million people to WellCare Health Plans, and Aetna may not sell new Medicare drug plans in 2020.

CMS says about 1,300 entities have agreed to participate in the Trump administration's first advanced alternative pay model, the Bundled Payments for Care Improvement Advanced, and Christina Smith Ritter, the director of the Patient Care Models Group at CMS' innovation center said that participation reflects an understanding that value-based pay is where the health care system is heading.