Power. Progress. Prevention. December 7, 2018

Published on December 7, 2018

Updated on January 4, 2019

Power. Progress. Prevention. -- An Advocacy Newsletter | Prevent Cancer Foundation

December 7, 2018

CMS announces new waiver concepts to give states more power

The Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma on Thursday announced new plans for waivers under section 1332 of the Affordable Care Act (ACA). The Section 1332 waivers are intended for states to create programs that increase access to health insurance—but these new changes could pose challenges for consumers. Most of the proposed models would change how states distribute subsidies, which are funds provided by the government that help people pay for their insurance policies.

The four new proposed waiver models include:

  • Account-based subsidies: States could direct funds from ACA subsidies into accounts that consumers can use to pay for their insurance premiums and out-of-pocket costs.
  • State-directed premium assistance: States could distribute federal funding from premium tax credits in ways that fall outside of current ACA regulations. For example, states could make subsidies available to people with higher incomes, taking away critical assistance from lower-income Americans.
  • Adjusted plan options: States could let consumers use their subsidies to purchase plans that don’t meet the requirements of the ACA, such as low coverage, short-term plans.
  • Risk stabilization strategies: States could use subsidies to continue state-based reinsurance programs, which can help stabilize premium prices for consumers. States could also adopt a high-risk pool, which would have a negative impact on health care costs for patients with more complex care needs.

While the Prevent Cancer Foundation® supports regulations that help make quality health insurance plans more affordable and accessible to Americans, we have concerns that the proposed waiver concepts could result in less comprehensive coverage. As CMS debates further changes, they should ensure all services are covered, including screenings and other preventive services. We will continue to monitor these regulations and provide updates as they occur.

To learn more about the proposed changes to the waiver process, read CMS’ press release.

HHS Secretary says CMS may allow hospitals to help with housing costs

In support of a more holistic approach to health care, Health and Human Service (HHS) Secretary Alex Azar spoke about the possibility of Medicaid payments being used for housing, healthy foods or other services. CMS’ ultimate goal is to spend less money on health care costs—which top $1 trillion a year for Medicare and Medicaid—and focus on giving Americans the tools they need to live healthier lives.

This would be a positive step toward addressing social factors that can impact health at the national level. We support provisions that can help break down barriers to healthy living and enable Americans reduce their cancer risk. To learn more, read this article from Modern Healthcare.

New changes coming to Medicare Drug Pricing

Last Monday, CMS proposed a new rule to lower drug prices for Medicare Advantage (Part C) and Prescription Drug Benefit (Part D) plans starting in 2020. This rule includes a few changes to the current pricing structure.

One major change would allow insurance companies to refuse coverage for the six protected classes of drugs, including drugs commonly used for cancer treatment, as long as at least two drugs in each category are covered. The six protected classes are antidepressants, antipsychotics, anticonvulsants, immunosuppressants for treatment of transplant rejection, antiretrovirals and atineoplastics. This rule may be harmful to patients who need more flexibility in medications from the six protected classes and could be denied coverage for drugs that are more expensive to insurers.

With this rule, Medicare patients could see lower drug prices, as their out-of-pocket cost will be calculated using prices closer to those paid by the pharmacies, rather than the initial list price. This would be beneficial to those who struggle with high out-of-pocket costs.

The Prevent Cancer Foundation® believes prescription drugs should be affordable, but that should not come at the expense of accessibility. Treatment decisions should be made between patients and their health care professionals based on the needs of the patient.  Any measure from CMS needs to ensure all medications are both accessible AND affordable. We will continue to monitor these regulations and provide further updates.

To learn more, read the proposed rule from CMS and submit your comments.

Ask your representative to support liver cancer prevention

Rep. Nydia Velazquez (D-NY) introduced the Liver Illness Visibility, Education, and Research (LIVER) Act of 2018 in October. This bill supports the creation and expansion of liver cancer prevention initiatives by establishing five years of funding solely for liver cancer research and programs. This includes $100 million a year in grants to the Centers for Disease Control and Prevention (CDC) and $45 million a year in research funding to the National Cancer Institute (NCI).

Since 1980, liver cancer rates have tripled, and more than 42,000 Americans will be diagnosed with liver cancer this year alone—it’s time to take action.

Use the Prevent Cancer Foundation’s action alert to tell your representatives to sign in support of this bill and save lives.

REMINDER: Open enrollment ends December 15 

Health insurance open enrollment for 2019 ends on December 15—don’t miss your chance to select a health insurance plan for next year.

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