Insights from the AHIP National Health Policy Conference

Last week, America’s Health Insurance Plans (AHIP) held its annual health policy conference (#AHIPPOLICY) in Washington DC, with top industry leaders, regulators and policy makers convened to provide diverse voices and perspectives on today’s most urgent health care issues. The conference themes were familiar and front-of-mind topics: tackling the opioid epidemic, rising prescription drug costs, data sharing and transparency (including the recent Interoperability and Patient Access Proposed Rule[1]), and highlighting recent advancements in technology that have improved care delivery and quality.

Investigation launched in response to the sale of STLDI

This year’s AHIP conference couldn’t have been more perfectly timed: several relevant news stories broke during the conference, giving speakers the opportunity to discuss these developments as they occurred. Energy and Commerce Chairman Frank Pallone, Jr. presented on the priorities from Capitol Hill, and announced that his committee was launching an investigation into twelve companies for practices related to the sale of Short Term-Limited Duration Insurance (STLDI) products. The final rules[2] related to expanded access and more flexible standards for Short Term Limited Duration Insurance were promulgated on August 1, 2018, opening up the sale of these products for longer time periods (with a 364-day initial policy term, and up to 36 months of renewal)- and required disclosure language to ensure consumers understand the product they are purchasing is not subject to all protections afforded under the ACA. States have taken action to protection consumers from misleading or incomplete information about STLDI plan offerings, and now Congress is looking into specific actions to ensure the sale practices are in line with standards set forth in federal law.

Medicaid Work Requirements

While Medicaid experts, including Cindy Mann (of Manatt, Phelps & Phillips, LLP) and Sara Rosenbaum (of George Washington University), presented on emerging issues affecting states and the Federal Medicaid program, arguments were being heard down the street at the D.C. District Court challenging the work requirement eligibility criteria approved in Arkansas’ and Kentucky’s Section 1115 Medicaid Demonstration Waivers. In back-to-back testimonies, Arkansas and Kentucky were asked to demonstrate that the approved work requirements further Medicaid’s underlying purpose of promoting health coverage for certain eligible populations.

As Cindy Mann commented during her presentation at AHIP, the hurdle for these states is demonstrating the experiment they have fashioned meets the core requirements of Medicaid, since the requirements by nature threaten their populations’ Medicaid coverage. A recent Kaiser Family Foundation report on the Arkansas community engagement program outlined that 18,164 otherwise eligible enrollees lost coverage in 2018, with only 8% reapplying and regaining coverage in 2019.  Additionally, the populations subject to work requirements were phased in over time—but as of January 2019, the total number of Arkansans subject to the work and reporting requirements was 105,158.

Kentucky, on the other hand, was back in court arguing the revisions they made to their waiver as a result of U.S. District Judge James Boasberg’s ruling this past summer are sufficient to demonstrate that the state Medicaid program is promoting health coverage. Kentucky plans to operationalize the approved waiver and begin work requirement eligibility implementation this summer.

Judge Boasberg promised a decision by the end of March, in advance of the next round of eligibility decision in Arkansas. Health Policy News will be following the ruling of Judge Boasberg, and providing insights into the impact in the April edition.

Update: on March 27, 2019, District Judge James Boasberg again ruled against the implementation of a Medicaid work requirement in Kentucky, while simultaneously ruling that Arkansas must halt the operation of its work requirement, vacating Secretary Azar’s approval of the waiver provisions in both states. We look forward to providing a more in-depth analysis on the Health Policy News blog, and in our April edition.

Precision Medicine

One known contributor to rising drugs costs is the innovation and personalized approach of precision medicine—in particular, advances made in particular in the area of gene therapy. While often expensive upfront, the long term cost of precision medicine could result in endless cost savings if individuals were able to receive treatment specifically tailored to their genetic mutations of certain diseases, like cancer. The esteemed director of the National Institutes of Health (NIH), Dr. Francis Collins, presented on what the Human Genome Project (HGP) has made possible and what is next for NIH as it builds upon the research of the HGP. In 2001, the cost to map an individual genome was $100,000,00 million dollars, with that same advancement estimated to cost $850 dollars in 2019. Dr. Collins noted that he could never have predicted the pace of growth, nor the possibilities currently available in the area of precision medicine when he first started on the HGP in 1993. It will be up to health issuers and states to figure out how to provide affordable access to these treatments and continue adapting to the ever-changing availability of treatment options made possible by scientific advancements in the medical field.

Dr. Collins closed by previewing an exciting undertaking at NIH, the All of Us Research Program, which aims to enroll the largest and most diverse field of research participants, and utilize the data gathered to further refine precision medicine. If you’re interested in being a part of this multi-year, historical research project, the All of Us Research Project is accepting volunteers. In signing up, you may learn more about yourself, while helping the medical research community learn more about all of us.

Footnotes:

[1] The proposed rule can be found here, with comments due May 3^rd.

[2] HPN summary of the final rules available here.

Published by Margot Thistle

Margot Thistle, Esq. is a managing editor of Health Policy News who has spent much of her career working directly on Affordable Care Act policy and implementation, including having lead plan management operational and policy planning for Vermont Health Connect, a state-based exchange. During her time at PCG, Ms. Thistle has worked extensively with state insurance departments and state agencies on health policy, market stabilization, and regulatory compliance matters. Ms. Thistle provides broad policy and regulatory support to PCG’s other health care clients across the country, analyzing policy and regulatory developments, providing strategic advice relative to regulatory questions, and drafting policy briefs and position papers. Ms. Thistle still has her admission ticket to the signing of Chapter 58 of the Acts of 2006, the historical Massachusetts health reform bill that preceded the ACA. View all posts by Margot Thistle