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CMS actuaries report suggests CBO overrated Obamacare’s individual mandate. A new report from actuaries at the Centers for Medicare and Medicaid Services has revealed that the Congressional Budget Office was way off in its estimates of the impact of Obamacare’s individual mandate, a miscalculation that has had significant ramifications for healthcare and tax policy over the past decade. CBO estimates about the importance of an individual mandate to a national healthcare scheme prodded President Barack Obama into including the unpopular provision into the law in the first place. The mandate projections also played a key role in President Trump’s two major legislative initiatives. The fact that the CBO assumed 14 million could lose coverage mainly due to the elimination of mandate penalties helped kill the effort to repeal and replace Obamacare, while its later assumption that 13 million fewer insured individuals would mean less spending on subsidies from the federal government helped get the 2017 Republican tax cut across the finish line by improving the budgetary math. Yet those incredibly influential estimates now appear to have been wildly off. In what was literally a footnote in its annual report on national health spending projections, CMS actuaries on Wednesday estimated that the elimination of the individual mandate would have a significantly smaller impact than the CBO has long estimated. Specifically, the CMS report revealed that 2.5 million more people would go without insurance in 2019 due to the repeal of the individual mandate’s penalties, and the impact would be “smaller” thereafter.

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Rising prices and an aging population to drive up healthcare spending after years of slow growth. An aging population coupled with more expensive medical goods and services will contribute to faster growth in healthcare spending in the coming decade, the study from CMS actuaries projected. National health spending is expected to grow at 5.5 percent a year on average from 2018 to 2027. Though this will be a faster rate than the decade prior, it’s still slower than it was from 1990 to 2007, when spending grew by an average of 7.3 percent a year. Spending on Medicare is expected to rise at a rate of 7.4 percent, driven by the aging of the baby-boom generation. On top of that, prices for healthcare goods are projected to grow an average of 2.5 percent per year for 2018 to 2027, which is faster than the 1.1 percent growth observed from 2014 to 2017.

Spending on prescription drugs projected to rise faster than spending for doctors and hospitals.  From 2020 to 2027, prescription drug spending is expected to increase by an average of 6.1 percent per year because more people will be picking up drugs at the pharmacy, whether because they need more medicine as they age or because they have better access to drugs to manage chronic illnesses. Adding to the cost is that, during the next decade, new, expensive drugs will become available. “The drug sector is the most difficult to project because if a new drug hits the market or a drug gets pulled because of safely reasons, there is a lot of volatility that it difficult to predict one or two years out,” Sean Keehan, economist for the National Health Statistics Group, said in a call with reporters. For hospitals, growth in spending is expected to average 5.7 percent in part because of higher wages for healthcare workers. Spending on doctors will increase by 5.4 percent annually. The report predicts a doctor shortage because of the aging population. As a result, it predicts the doctors who are working will also have higher wages. Spending figures for doctors and hospitals include the costs of drugs that are administered at doctors’ offices, such as those used for chemotherapy.

Healthcare spending to take up nearly a fifth of the economy. During the next decade, healthcare spending will outpace economic output as a whole, and accordingly, healthcare’s share of the economy is expected to rise from 17.9 percent in 2017 to 19.4 percent in 2027.

Florida governor says Trump is ‘enthusiastic’ about state plan to import prescription drugs from Canada. Republican Gov. Ron DeSantis said he has buy-in from President Trump to use Medicare to help Florida import cheaper drugs from Canada. DeSantis, speaking at a press conference in the Villages in Florida on Wednesday, said he spoke to Trump Sunday and Monday and that the president was “enthusiastic” about the proposal and would take “necessary executive actions to make sure that we can act” through Medicare’s prescription drug program.“Our state budget, we pay huge amounts of money for prescription drugs, including tens of millions of dollars for prisoners’ drugs … It’s a real burden on the taxpayer,” DeSantis said. “This is something that we will be doing in conjunction with the Trump administration. Basically, what we’re going to be doing is recognizing that some of these same drugs, if you were just in Canada, would be a fraction of the price.” At the press conference, state House Speaker Jose Oliva, a Republican, vowed that he would work with DeSantis and Trump. “[DeSantis’] relationship with the president is going to have a tremendous effect,” Oliva said.

Democrats blast Trump administration over proposed Obamacare rule. Democrats slammed the Trump administration in a letter this week over changes it is considering to the Obamacare markets and to open enrollment, accusing the administration of working to increase costs and the number of uninsured. “In this proposed rule alone, you propose policies that will increase premiums, make it more difficult to compare plans, increase the likelihood that patients will lose access to their medications, and make it harder for women to access comprehensive reproductive health services,” they wrote. ”The Trump administration asked for feedback about “silver loading,” a practice that allows insurers to shift costs to the government to help them subsidize out-of-pocket expenses, as they are required to by law. It also asked about automatic re-enrollment in plans and making sure that insurers in every state provide plans that don’t cover abortions.

Hospital groups present suggestions against surprise medical bills. Six hospital industry groups, representing for-profit, non-profit and hospitals that serve the most vulnerable patients, warned congressional leaders in a letter on Wednesday against seeking solutions to surprise medical bills that would have the government set payment rates. The groups mostly focused on how insurance companies could make sure that patients don’t get surprise medical bills. They recommended that Congress enforce rules that have insurers pay for emergency services, so that insurers can’t contest whether patients truly faced an emergency, and that insurers not bill a patient for hospital services they won’t cover. Patients face high, unexpected costs their insurance company won’t pick up when they see providers outside of their networks, when particular drugs are given to them that they don’t know are expensive, or when insurers won’t cover the full bill.

Rural hospitals face widespread closures. One in five hospitals in rural areas are at risk of closing, despite being vital to their communities. A Navigant study revealed that hardest-hit regions would be the South and the Midwest, which experience low population growth creating an excess of hospital space. A 2017 bipartisan measure, called the Rural Emergency Acute Care Hospital Act, put forth by Sens. Chuck Grassley, R-Iowa, Amy Klobuchar, D-Minn., and Cory Gardner, R-Colo., acknowledges this issue and and seeks to create new Medicare classification under which rural hospitals would offer emergency and outpatient services.

Playbook on Medicaid buy-in released. The United States of Care on Wednesday released a “Playbook” on Wednesday to help policymakers in states that want to create a Medicaid buy-in. The provision would allow Medicaid to compete against private plans to offer health insurance, but can be carried out in different ways. The playbook lays out some of these options, including the possibility of states subsidizing the plans, having people purchase Medicaid directly, or create a waiver that will allow people at higher income levels to receive subsidies after more people buy into Medicaid. The organization was founded by Andy Slavitt, who led CMS under the Obama administration.

WHO: Countries are spending more on health, but people are still paying too much out of their own pockets. Spending on healthcare is growing faster than the rest of the global economy, according to a study out Wednesday from the World Health Organization. The study showed that the rate of spending is higher in low- and middle-income countries than in high-income countries. On average, governments provide about 51 percent of a country’s health spending, whereas 35 percent of spending comes from out-of-pocket expenses, thrusting about 100 million people into extreme poverty. WHO officials conclude that government spending increases on healthcare can improve economic outcomes and create safer societies.  

Welch unveils legislation to bring down soaring insulin prices. Rep. Peter Welch, D-Vt., unveiled legislation on Wednesday aimed at reducing the prices of insulin for diabetes patients. His bill authorizes the importation of low-cost insulin from other countries, including Canada. Welch said drug companies created a pricing monopoly, resulting in insulin prices tripling in the last 10 years. The bill authorizes importation from Canada and gives the Food and Drug Administration the authority after two years to expand to other countries that show they have similar safety standards as the U.S. The FDA would be responsible for inspecting all insulin that has been imported.

RUNDOWN

Kaiser Health News More States Say Doctors Must Offer Overdose Reversal Drug Along With Opioids

The Hill Johnson & Johnson subpoenaed by DOJ and SEC, company says

The Washington Post Spending forecast offers ammunition — and some alarm — for Democrats pushing Medicare expansion

The Seattle Times Measles epidemic in Madagascar kills more than 900, says WHO

TIME Why food could be the best medicine of all