Good morning ... The next few weeks will be critical in determining how big an imprint President Trump leaves on the health care system. With his nominee to lead HHS advancing and the individual mandate back on the chopping block, that imprint is looking bigger every day.
It's not over yet, but Republicans' tax plan had a good day yesterday — and that means the Affordable Care Act's individual mandate is, yet again, in serious jeopardy.
Yes, but: Trump endorsing a new reinsurance program — which would cost roughly $5 billion over two years — does not necessarily mean House Republicans would be on board.
Be smart: The two measures Republicans are eyeing as ways to soften the blow from the individual mandate are probably inadequate.
Alex Azar heads to the Senate HELP Committee today for the first hearing on his way to confirmation as the next secretary of the Health and Human Services Department. HELP won't formally report his nomination to the full Senate, but he's sure to face aggressive questioning today from Democrats.
What we're hearing: Republicans will likely tread pretty easily on Azar, but a Democratic aide outlined three areas Democrats' questioning will likely focus on:
The other side: HELP chairman Alexander plans to say in his opening statement:"You have been confirmed by the Senate twice. ... You have served in the judicial branch as a law clerk for Justice Antonin Scalia and you know the executive branch, having been HHS General Counsel and Deputy Secretary. And you know the private sector."
Go deeper: The hearing starts at 9:30am. You can watch the livestream here.
The Centers for Medicare & Medicaid Services has rolled out a preliminary look at a crucial payment rate for Medicare Advantage plans, and it looks like insurers are in line for a sizable pay increase, Bob Herman reports.
The details: The federal government pays Medicare Advantage companies lump sums of money through a complicated formula. A main component of that formula, called the fee-for-service growth rate, is expected to be 4.29% for 2019.
How it compares: That's up from the 2.31% CMS projected for the 2018 rates. The growth rate could go up even more by the time final rates are released in April, but the numbers are still very preliminary.
Why it matters: This market is massive, and only getting bigger. Medicare Advantage insurers are estimated to receive about $248 billion in 2019, according to the Congressional Budget Office.
Remember when high-deductible health plans were supposed to make people pay more attention to the cost of their medical care? It's not happening yet, according to a new study in the Journal of the American Medical Association.
Among people who had high-deductible plans, surveyed from August 26, 2016, through September 19, 2016:
The bottom line: If people don't become more cost-conscious and avoid unnecessarily expensive medical procedures even when they have more "skin in the game," that undermines a big argument for shifting more people into high-deductible plans. The trend toward higher out-of-pocket costs isn't likely to change, though, because it does help employers control how much they spend on health benefits.
As long as we're talking about cost consciousness, it's worth remembering that patients don't always have total control over what medical procedures are thrown at them. That's the lesson of an alarming story ProPublica posted yesterday, featuring a hospital that charged $1,877 to pierce a 5-year-old's ears.
The back story: No, the hospital didn't say, "Hey, would you like a $1,877 ear piercing for your daughter?" The girl was there for an unrelated, minor outpatient procedure, and the surgeon offered to do the ear piercing as long as she was there. The mother assumed it would be free — and then found out it wasn't when the insurer refused to pay for it.
The big picture: It's an extreme case, but ProPublica cites other examples of patients who got procedures because they were presented with little to no choice. It's hard to see that changing until there's a broader public awareness of wasteful spending — and patients learn to push back.
What we're watching today: Azar's confirmation hearing.
What we're watching this week: HELP hearing Thursday on the opioid crisis. House Energy and Commerce subcommittee hearing Thursday on implementation of the 21st Century Cures Act.
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