KHN’s ‘What the Health?’: Here Comes Reconciliation

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The expansion of health benefits is a major piece of the tentative budget deal reached this week by Democrats in Congress. They plan to press ahead — without Republican support — on a bill that could expand Medicare, extend the generous premium subsidies for the Affordable Care Act and provide options for people with low incomes who have been shut out of coverage in states that didn’t expand Medicaid. It could be paid for, at least in part, by changes aimed at reducing prescription drug prices. But that assumes Democrats can reach an agreement on the details, because the bill cannot pass without every Democrat in the Senate and nearly every Democrat in the House.

Meanwhile, controversy continues over the Food and Drug Administration’s approval of Aduhelm, a controversial — and expensive — drug to treat Alzheimer’s disease that has not yet demonstrated a clear benefit.

This week’s panelists are Julie Rovner of KHN, Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

• The Democrat’s $3.5 trillion reconciliation plan for increasing spending on “human infrastructure” has an ambitious agenda for revamping the country’s health care system, which includes adding dental, vision and hearing benefits to Medicare, extending the more generous subsidies for premiums on the ACA’s insurance marketplaces and lowering prescription drug prices. Much negotiation is still expected and the Senate may not agree to the full package.
• Many details of the package have not been publicly revealed, but it appears that this plan would not lower the eligibility age for Medicare, which has been a rallying cry for some Democrats, including President Joe Biden. The hospital industry, which generally earns less for patients covered by Medicare than those with private insurance, would likely fight such a proposal.
• Adding benefits to Medicare has been politically popular and could influence a key voting bloc in next year’s congressional midterm election.
• The Biden administration announced this week that the latest enrollment numbers show 2 million consumers have signed up for insurance on the ACA’s marketplace during a special enrollment period announced by the president in February. The enhanced subsidies provided in a covid relief law has helped propel those numbers.
• The controversy over whether consumers need a booster covid vaccine is confusing for the public. Pfizer, which makes one of the vaccines, says its studies suggest the public would benefit from a third shot, but federal health officials say they haven’t seen any evidence yet that those who have been inoculated are losing immunity.
• Biden’s executive order last week seeking to improve U.S. competitiveness affects many aspects of health care. He called on the Department of Health and Human Services to produce a plan to reduce prescription drug prices and the Federal Trade Commission to more closely scrutinize hospital mergers, which may consolidate services and lead to higher prices.
• The order on competitiveness suggested the administration is willing to accept the Trump administration’s moves to allow drugs to be imported from Canada and other countries where prices are lower. But the effectiveness of that program is suspect since Canada and Europe do not appear to have enough drug supplies to provide a steady stream of medications to the U.S.
• Medicare officials announced that the federal health program is embarking on a nine-month study to see if and how it should cover Aduhelm. Some private insurers have said they won’t cover the drug but Medicare’s decision may influence their thinking.
• Janet Woodcock, acting head of the FDA, has asked the inspector general at HHS to investigate whether proper procedures were followed in the approval process. She stands behind the decision but is reacting to press reports that some FDA employees may have had unusual talks with the drugmaker before the decision was made.

Also this week, Rovner interviews Rae Ellen Bichell, who reported the latest KHN-NPR “Bill of the Month” episode about a mother, daughter and a gigantic emergency room bill. If you have an outrageous medical bill you’d like to send us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The Los Angeles Times’ “Botched Surgeries and Death: How the California Medical Board Keeps Negligent Doctors in Business,” by Jack Dolan and Kim Christensen

Rachel Cohrs: Politico’s “Plugging Obamacare’s Biggest Hole Poses Dilemma for Democrats,” by Rachel Roubein and Alice Miranda Ollstein

Sarah Karlin-Smith: KHN’s “Government Oversight of Covid Air Cleaners Leaves Gaping Holes,” by Lauren Weber and Christina Jewett

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KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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