States push back against junk health insurance

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Sep 11, 2023 View in browser   By Chelsea Cirruzzo and Ben Leonard Presented by With Kelly Hooper Driving the Day "Junk" insurance plans might be tempting for people no longer eligible for Medicaid. | AP STATES WARN AGAINST LIMITED PLANS — As millions of people lose Medicaid, states are spending big by refining their outreach to prevent consumers from being duped into buying so-called junk health insurance plans, Kelly reports. The plans offer limited benefits, fixed payouts or last less than 12 months — but don’t have to comply with the Affordable Care Act’s coverage rules and have historically left people on the hook for medical bills. As states unwind a pandemic-era law that allowed people to stay on Medicaid even if they were no longer eligible, many of them will need new coverage and could end up in a plan without understanding its drawbacks, some state officials told POLITICO. Massachusetts has spent $1.5 million to expand its navigator program — which provides enrollment assistance — during the Medicaid unwinding period, an official told POLITICO. The Washington, D.C., health insurance marketplace has taken a similar approach, shifting its navigator program to focus on Medicaid unwinding; typically at this time, the program’s staff would be working on special enrollment outreach and events, said executive director Mila Kofman. Background: Short-term health plans and limited benefit products like fixed indemnity plans are sometimes marketed as comprehensive health coverage even though they often don’t cover all essential health services, according to a Georgetown Center on Health Insurance Reforms secret shopper study. People who lose Medicaid might be eligible for $0 premium plans on the ACA marketplace, meaning the vast majority of short-term plans and limited benefit products aren’t cheaper options, state officials said. But the Georgetown study found most limited-plan sales reps failed to mention the income-based marketplace subsidies or implied that subsidies were unavailable outside of the annual open-enrollment period. But conservative policy experts say short-term health plans don’t undermine state marketplaces and states shouldn’t try to keep people from them. “I don't think the government should be saying there are some products out there that people can buy that are better than other products,” said Brian Blase, president of the right-leaning Paragon Health Institute and a former Trump policy adviser who worked on the 2018 rule expanding short-term health plans. What’s next: The Biden administration is attempting to crack down on junk plans with a proposed rule that would limit short-term health plans’ duration to three months, scaling back the Trump administration’s 2018 expansion that allowed the coverage to last a full year and be renewed for an additional two years. WELCOME TO MONDAY PULSE. Thought this summer was hot in Washington? Well, it was hot for everyone else in the world, too. Fall, where are you? Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo. TODAY ON OUR PULSE CHECK PODCAST, host Robert King talks with POLITICO health care reporter Kelly Hooper, who takes a closer look at what states are doing to warn consumers about junk health insurance plans. Listen to today’s Pulse Check podcast   A message from PhRMA: Middlemen can profit from where patients fill their prescriptions. Because insurance companies and PBMs own pharmacies, too.   In Congress Sen. Bernie Sanders says he will no longer delay the nomination for an NIH leader. | Francis Chung/POLITICO NIH CONFIRMATION HOLDUP REVERSED — A confirmation hearing for Dr. Monica Bertagnolli, tapped to lead the NIH, will finally be held next month after the White House acquiesced to some demands made by Senate health committee chair Bernie Sanders (I-Vt.), POLITICO’S Erin Schumaker reports. The senator has held up Bertagnolli’s nomination since spring, saying he needed to see more action from Biden to lower drug prices. What’s changed: Sanders said in a statement his concerns were somewhat assuaged by “recent actions taken by HHS and a commitment I received from the White House to keep working to lower the price of prescription drugs.” He also pledged to drop his blanket opposition to holding hearings for all administration health nominees, a Sanders spokesperson confirmed to POLITICO. The news came shortly after the Biden administration announced an agreement Friday between HHS and the biotech company Regeneron. One clause of the agreement says that if the company develops a next-generation monoclonal antibody treatment for Covid-19 and fully licenses it after FDA approval, the list price in the U.S. must be equal to or less than the price in other major countries. Despite Sanders’ softened position, the commitment from the White House and HHS fell short of the sweeping drug pricing reforms the senator had previously called for — which Sanders noted in his statement. INSIDE THE GOP HEALTH PACKAGE — House Republican leaders have unveiled their sweeping health package aimed at boosting transparency in the health care system and addressing drug costs, boasting bipartisan support, Ben reports. The package is from top Republican House Energy and Commerce, Ways and Means, and Education and the Workforce committee leaders but doesn’t have the backing of the ranking Democrats on the Ways and Means or Education and the Workforce committees. The former had previously raised concerns about the bill not including transparency requirements surrounding private equity ownership of health care firms. What’s changed: The package released Friday incorporates significant updates to boost hospital price transparency. It requires hospitals to attest that posted prices are accurate and release negotiated rates, gives the HHS secretary more discretion to increase fines for violations and requires the HHS secretary to certify any hardship exemptions. Also included in the bill is a mandate that Medicare pay the same for physician-administered drugs in a hospital outpatient department as beneficiaries do in a doctor’s office.   DOWNLOAD THE POLITICO APP: Stay in the know with the POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need. DOWNLOAD FOR iOS – DOWNLOAD FOR ANDROID.     Public Health FAUCI: WINTER COVID UPTICK LIKELY — The former U.S. top infectious disease control expert isn’t worried yet about rising Covid-19 case numbers in the U.S. but says to be wary of a winter uptick, POLITICO’s Kelly Garrity reports. Dr. Anthony Fauci said on ABC’s “This Week” on Sunday that a steady increase in cases since July is likely to continue in the cold months — though he doesn’t expect to see any federal mask mandates. “I mean, I can see that if we get a significant uptick in cases that you may see the recommendation that masks be used under certain circumstances and indoor crowded settings, but … certainly not federal mandates,” Fauci said. What to watch: Updated Covid shots, designed to protect against dominant variants, will likely see FDA authorization this week. A CDC vaccine advisory committee is scheduled to meet Tuesday. In the Courts ABORTION PILL APPEAL — The future of the most popular method of terminating a pregnancy is back before the Supreme Court after the Biden administration and drugmaker Danco appealed a lower court ruling rolling back access to the drug, POLITICO’s Alice Miranda Ollstein reports. Background: A district judge struck down the FDA’s approval of abortion drug mifepristone nationwide and issued a de facto ban on the pills in April. A few weeks later, a three-judge panel at the 5th U.S. Circuit Court of Appeals partially upheld and partially overruled that decision, maintaining federal approval of the pills but sharply limiting who can get them. The Supreme Court intervened later that month, pausing any implementation of those lower court orders. Why it matters: The looming case is expected to be the most sweeping abortion issue the high court has examined since overturning Roe v. Wade, with implications that extend far beyond reproductive health and could impact how a vast array of drugs are approved and regulated. What’s next: The appeals don’t automatically mean the Supreme Court will hear the case. The justices will first receive a preliminary round of briefing before deciding whether to add the case to the court's merits docket.   A message from PhRMA:   Mental Health 988 ADDS SIGN LANGUAGE — The 988 mental health crisis line now has American Sign Language services for callers who are deaf and hard-of-hearing users, HHS announced Friday. It’s the latest investment the administration has made in the line, which turned one year old this summer. Since launching, 988 has added text and chat functions, Spanish-speaking services and specialized services for LGBTQ people. But, while growth in usage rates has steadily climbed in recent months, the administration is still trying to make more people aware of the line. This summer, a National Alliance on Mental Illness/Ipsos poll found that 82 percent of Americans were unfamiliar with 988. Miriam Delphin-Rittmon, SAMHSA’s assistant secretary, told Chelsea that the agency is working on a campaign with the Ad Council and the Suicide Prevention Resource Center to develop specific messaging for groups like young people underusing the line. The agency also plans to work with “trusted messengers,” including leaders in faith communities, who can help get the word out.   JOIN US ON 9/12 FOR A TALK ON THE NEW AGE OF TRAVELING: In this new era of American travel, trending preferences like wellness tourism, alternative lodging and work-from-anywhere culture provide new but challenging opportunities for industry and policy leaders alike. Join POLITICO on Sept. 12 for an expert discussion examining how the resilience of the tourism and travel industries is driving post-pandemic recovery. REGISTER HERE.     Names in the News Former acting CMS chief Kerry Weems has died at the age of 66. Weems had been appointed under then-President George Bush in 2007 but was never officially confirmed by the Senate. Adam Cohen has been named deputy director of the White House Office of National Drug Control Policy. Cohen was previously the director of the Executive Office of the Organized Crime Drug Enforcement Task Forces at the U.S. Department of Justice. What We're Reading Health Affairs writes that the DEA should implement a special registration for telemedicine prescribing of drug-assisted treatment. Science reports on the scientist who paved the way for weight-loss drugs — and how she was erased from the narrative. The Washington Post reports on a 5th Circuit ruling that the White House and the CDC likely violated the First Amendment through their contact with tech companies.   A message from PhRMA: Insurance companies and pharmacy benefit managers (PBMs) are putting their profits before your health. That’s because the largest PBMs own or are owned by the largest insurance companies, and they own pharmacies, too. First the PBM can deny coverage for your medicine in favor of one that makes them more money. Then, they steer you to the pharmacy they own. Without you ever knowing why it all happens this way. See what else they do.     Follow us on Twitter Dan Goldberg @dancgoldberg Chelsea Cirruzzo @chelseacirruzzo Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Evan Peng @thepngfile Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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