August 28, 2017

Good morning ... Vitals is back, and I wish we were coming back to better news. Hoping my Texas friends are safe and dry, and with power. If you're looking for ways to help, Texas Gov. Greg Abbott and city leaders say the American Red Cross is your best bet:, or 1-800-RED-CROSS. (You can make a $10 donation by texting HARVEY to 90999.)

Meantime, we've got a look at why a delay in Affordable Care Act taxes is considered a must-do by industry lobbying groups, and yet there's no clear path forward.

What could happen next on ACA taxes

Technically, ACA stabilization and reauthorization of the Children's Health Insurance Program are at the top of the health care to-do list when Congress returns next week. But there's also going to be a big industry push to delay two of the ACA's main taxes: the ones targeting health insurers and medical devices. The catch, as Caitlin Owens reports this morning, is that there's no clear vehicle for doing it.

The ACA stabilization package is already complicated enough, Caitlin reports, and GOP leaders don't want the tax reform efforts to deal with any health care taxes. The government funding and debt ceiling legislation will be tough too.

The bottom line: Keep an eye on the government funding bill — since that's where ACA taxes were put on hold two years ago — and maybe the CHIP bill. But as one lobbyist told Caitlin: "It is a have-to-get-done that's really hard to get done."

Pharma leads profitable second quarter for health care

Bob Herman looked through financial documents for 58 publicly traded health care companies to see who the profit leaders are. The answer probably isn't a surprise: It's the pharmaceutical industry. Brand-name pharmaceutical companies and health insurers increased their profits in the second quarter of this year, while hospitals and drug distributors had a more difficult run.

Between the lines: Drug companies continue to raise their list prices for branded drugs despite the public furor, so they naturally maintained their status as the most profitable sector in health care. Insurers also collected higher profits because fewer people are going to the hospital or doctor, which results in more money staying in their pockets.

Read more here.

Why narrow networks matter in hurricanes...

Sure, there are things that matter more than health insurance when you're in the path of a hurricane — like survival. But David Anderson, a former health insurance company official who writes the Balloon Juice blog, points out why narrow provider networks could be a big problem for people who evacuated to get away from Hurricane Harvey:

  • If someone who evacuated needs urgent care, like treatment for an asthma attack or an ongoing mental health condition, they may be hundreds of miles away from any doctor or clinic that's in their network.
  • And if they go to an out-of-network provider, which may be their only choice, they could be stuck with higher bills.

What to do: They should call their insurance company ahead of time and get a pre-authorization to go to an out-of-network provider. And they can point to this advisory from the Texas Department of Insurance, which seems to be trying to prevent exactly this kind of problem.

Key quote: "Under these circumstances, it is the opinion of the Texas Department of Insurance that all health insurance companies and health maintenance organizations should waive penalties and restrictions ... [for] necessary emergency and nonemergency health and dental services out-of-network as a result of the disaster."

Why it matters: It may seem like an easy problem to solve, but nothing is easy with health insurance bureaucracies — even for people who know how the system works. (Trust me on this.) If you work for a health insurer, please be nice to stressed-out evacuees.

...and why employers want more of them

Narrow networks definitely have been an issue with the ACA, but now they're an increasingly popular cost-cutting strategy for employers, too. Forbes reports that nearly half of all large employers are looking for ways to narrow their health plans' networks of doctors and hospitals. But they're pitching it as a way to improve quality, not just cut costs, by focusing on the providers who have the best quality ratings.

Between the lines: Sure, they might be able to cut costs and improve quality. But as economist Austin Frakt has written, there have also been signs that people in California's ACA narrow-network plans had trouble getting appointments with primary care doctors. So take note, employers: Your employees will only be happy with narrow-network plans if they're managed well.

While we were week-offing...

  • Kaiser Health News reports that venture capitalist Peter Thiel and other U.S. business people are backing the offshore testing of an experimental herpes vaccine that evades FDA safety protections.
  • A new drug study suggests that reducing inflammation could be a way to treat heart disease, beyond just reducing cholesterol, according to The Washington Post.
  • The New York Times writes that even as well-known insurers pull out of the ACA markets, the ones that have remained have narrowed their losses, and some are even starting to make money.
  • Rep. Steve Stivers, the chairman of the National Republican Congressional Committee, says it's clear “in hindsight" that it was a mistake to try to repeal the ACA before moving on to other issues, The Hill reports.
  • Google has teamed up with the National Alliance on Mental Illness to create a test for clinical depression, per CNBC.

What we're watching next week: Senate HELP Committee hearings on bipartisan ACA stabilization bill, Sept. 6 and 7; markup of Senate funding bill for HHS, dates TBD.

What we're watching in September: Senate Finance Committee hearing on CHIP reauthorization. Also, Healthcare Security Forum, sponsored by the Healthcare Information and Management Systems Society, Sept. 11-13.

Let me know what else is at the top of your post-Labor Day health care list: [email protected].