Daily on Healthcare: Judge to rule soon on whether to strike Medicaid work rules

Judge to rule soon on whether to strike Medicaid work rules: Federal Judge James Boasberg of the U.S. District Court for the District of Columbia said he planned to rule before April 1 on two separate but related cases involving Medicaid work rules in Kentucky and Arkansas.

The Trump administration defended Medicaid work rules in federal court Thursday, in disputes that ultimately centered on defining what the purpose of the program should be. At issue were rules the Trump administration approved in Arkansas and Kentucky that obligate people to work, volunteer, or take classes for 80 hours a month as a condition of being allowed to remain in Medicaid.

Arkansas argument: The Trump administration asked Boasberg to dismiss the challenge against work rules in Arkansas on the basis that doing so would be too disruptive to the state. Arkansas is the only state that has made its work program official, and the Trump administration said it would like to see the program continue so that it could receive data on how well the idea worked.

But the plaintiffs and Boasberg raised the fact that the Arkansas program had resulted in 18,000 people being kicked off of Medicaid within seven months. When the Trump administration stressed the program was intended to help people improve their lives, Boasberg shot back, “That’s not the purpose of Medicaid.”

Kentucky argument: The Trump administration brought attention to the fact that the commonwealth’s Republican governor, Matt Bevin, had threatened to end the Medicaid expansion if the work rules were not to go into effect. In this case, the Trump administration said that if the purpose of approving changes to Medicaid would be to expand coverage then striking down the work requirements could have the effect of kicking even more people off coverage.

Ian Heath Gershengorn, the attorney representing the plaintiffs, said Bevin couldn’t unilaterally undo the expansion. He noted the governor was up for re-election and that such decisions on Medicaid may be politically unpopular.

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Hospitals bottom lines hurt by work requirements: Study. Hospitals stand to lose billions of dollars if states press forward with implementing work requirements, according to a report published Thursday by the Commonwealth Fund. If all states were to implement the requirements that the Trump administration approved, and people were to become uninsured as a result, then hospitals would treat more patients who couldn’t pay medical bills and could lose between $3.7 billion and $4.1 billion in 2019.

CMS sets rules for how states can track their Medicaid programs: The Centers for Medicare and Medicaid Services on Thursday announced a new set of tracking tools so that states can see how well their changes to Medicaid are working. The changes specifically deal with 1115 waivers, the same kinds of waivers that states used to set up Medicaid work requirements, but also would track how well programs are working that make beneficiaries pay premiums.

The Trump administration will have states provide regular reporting that has been conducted by an independent evaluator. On Thursday, it posted examples of how states could document their outcomes, what information states would need to provide, and what questions officials should be asking as they assess their programs. “We are continually looking for ways to support state flexibility with greater accountability for program performance,” CMS Administrator Seema Verma said in a statement. “The best ideas from state leaders are worth testing, so we will continue to support Medicaid demonstrations paired with robust monitoring and rigorous evaluations.”

Here’s what came out Azar’s last day of budget hearings:

He warned of long fight ahead on the opioid crisis: Health and Human Services Secretary Alex Azar said during a Senate Finance Committee hearing Thursday that the government was seeing results in its efforts to stop the opioid crisis, but that success would not come easily. Sen. Maggie Hassan, D-N.H., warned that the Trump administration’s proposed cuts to Medicaid would make it harder for her state to address its opioid crisis. Azar countered that the proposal to turn Medicaid into a block grant, which limits spending but gives states more flexibility to spend the funds, would “actually allow a much more targeted, focused approach.”

He acknowledged states are asking about Medicaid block grants: Azar acknowledged states were asking about block grants during questioning with Sen. Bob Casey, D-Pa. “There may be states that have asked about block granting, per capita, structurings around expansion populations… it’s at their instigation,” he said. When Casey asked for those negotiations to become public, however, Azar declined, saying it would violate the department’s ability to work closely with governors and state officials.

He said NIH could meet the budget cuts: Azar said that while the decision to cut the budget for the National Institutes of Health by $5.5 billion was difficult, but that it was in accordance with a deal to set budget caps by 2020 struck between Congress and former President Barack Obama. “I’m sure we can economize if Congress were to work with the administration on a change on overall caps, or if Congress takes a different approach we’re obviously going to work with you on that,” he said.

Government releases new medicine data to help customers see price increases: CMS has updated its drug pricing website with 2017 data, which tracks how much government healthcare programs spent over time for different drugs. From 2013-2017, prescription drug spending grew by an average yearly rate of 10.6 percent in Medicare Part D, which pays for drugs in the pharmacy; 10 percent in Part B, which pays for drugs administered in a hospital or doctor’s office; and 14.8 percent in Medicaid, which covers disabled and low-income people. Total gross spending on prescription drugs in 2017 was $154.9 billion in Medicare Part D, $30.4 billion in Part B, and $67.6 billion in Medicaid. “Today’s update to the drug dashboards continues the Trump Administration’s commitment to price transparency,” Verma said in a statement.

Nasal spray vaccine good to use for kids this coming flu season, pediatricians say: The American Academy of Pediatrics says families can vaccinate their children using the nasal spray or the shot to protect against the 2019-2020 flu season. That’s different from the flu season underway now, when AAP had a preference for the shot after data showed the spray had been less effective during certain flu seasons. The two seasons prior, it had not recommended the nasal spray, but then the manufacturer made changes in 2017. “Every year, we are never sure if the vaccine strains are going to be perfectly matched up with incoming flu strains, but based on the information that we have now, we believe the nasal spray is an acceptable option,” Dr. Bonnie Maldonado, chair of the AAP Committee on Infectious Diseases, said in a statement.

Bipartisan bill would make insurers pay more for cancer drugs: Reps. Brian Higgins, D -N.Y., Brett Guthrie, R-Ky., Doris Matsui, D-Calif., and Gus Bilirakis, R-Fla., on Thursday introduced the Cancer Drug Parity Act, a bill requiring health insurance plans to cover cancer drugs people take orally at the same rate as they cover injectable cancer medications. Under current law, injections are covered in health insurance plans as part of an insurer’s “medical” benefit, meaning it has fewer copays for patients, while drugs people take orally are covered under the prescription drug portion of plans, which is more costly to patients. “Insurance companies shouldn’t be allowed to pick and choose what kind of treatment a cancer patient should receive” Matsui said.

Democrats re-introduce paid sick leave bill: Rep. Rosa DeLauro, D-Conn., and Sen. Patty Murray, D-Wash., reintroduced the Healthy Families Act on Thursday, which would provide workers with paid sick leave to use when they are ill, when they need to care for a sick relative, to obtain preventive care, or to address effects of sexual assault, domestic violence, or stalking. Businesses that already provide paid sick leave would not have to change their current policies, as long as they meet the minimum standards. In advocating for the bill, the lawmakers presented studies showing that sick paid leave can reduce the spread of contagious illnesses such as the flu and projected that a national paid sick days policy would reduce emergency room visits by 1.3 million annually, saving $1.1 billion a year.

The Rundown

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The New York Times How big tobacco hooked children on sugary drinks

St. Louis Post-Dispatch Mental health program being tried in Missouri gets support from Roy Blunt

The Seattle Times Should the legislature bring universal health care to Washington?

Bangor Daily News Janet Mills submits bill to let medical professionals who aren’t physicians perform abortions

Calendar

FRIDAY | March 14

March 13-16. American Bar Association 20th Annual Emerging Issues in Healthcare Law Conference. Agenda.

March 13-14. America’s Health Insurance Plans health policy conference. Agenda.

March 14-15. Meeting of the Presidential Advisory Council on HIV/AIDS. Details.

MONDAY | March 18

March 18-21. National HIV Prevention conference. Program.

TUESDAY | March 19

2:30 p.m. 1775 Massachusetts Ave. NW. Brookings interview with departing Food and Drug Administration Commissioner Scott Gottlieb. Details.

THURSDAY | March 21

10:30 a.m. 1225 I St. NW. Bipartisan Policy Center event on “Overcoming Health Care Challenges in Immigrant Communities.” Details.