Budget Deal Could Adversely Impact 21st Century Cures

The two-year budget deal passed by Congress last week used $5.4 billion in offsets that had already been proposed to pay for the 21st Century Cures Act (H.R. 6), passed by the House earlier this year. The pay for comes from a sale of oil from the Strategic Petroleum Reserve (SPR). It is unclear whether there is enough oil in the stockpile to accomplish multiple goals, or whether lawmakers on the House Energy and Commerce Committee must now renegotiate new offsets for the bill, which would overhaul the drug and device development and approval process. The budget deal could also impact movement on reconciliation, as it too used the $7.9 billion in savings resulting from repeal of a provision in the Affordable Care Act (ACA) known as the employer auto-enrollment requirement.

Paul Ryan Elected Speaker of the House

Rep. Paul Ryan (R-Wis.) was elected Speaker of the House last week. Ryan’s only challenger was Rep. Daniel Webster (R-Fla.). Ryan beat Webster in the closed-door Republican conference meeting by a 200-43 vote. On the floor, Ryan received 236 votes for Speaker – more than the 218 required to win on the first ballot. Rep. Daniel Webster received nine votes from the floor. Webster was backed by Rep. Dave Brat (R-Va.), Rep. Curt Clawson (Fla.), Rep. Louie Gohmert (R-Texas), Rep. Paul Gosar (R-Ariz.), Rep. Walter Jones (R-N.C.), Rep. Thomas Massie (R-Ky.), Rep. Bill Posey (R-Fla.), Rep. Randy Webber (R-Texas), and Rep. Ted Yoho (R-Fla.). Minority Leader Nancy Pelosi (D-Calif.) received 184 Democratic votes. Mirroring their votes during the Speaker’s contest in January, Rep. Krysten Sinema (D-Ariz.) voted for Rep. John Lewis (D-Ga.) and Rep. Gwen Graham (D-Fla.) voted for Rep. Jim Cooper (D-Tenn.), while Rep. Cooper voted for former Secretary of State Colin Powell. In response to complaints from rank and file membership pushing for more say in the decision-making process, Ryan has planned a series of meetings for later this month to discuss changes to internal GOP rules that would allow more votes to come to the floor, and to potentially overhaul the process by which members are assigned to committees. Ryan is still, however, in favor of making it more difficult for members to oust the Speaker from his leadership position. Outgoing Speaker John Boehner (R-Ohio) officially submitted his resignation on Thursday. After being sworn in as Speaker, Ryan resigned his position as chairman of the powerful Ways and Means Committee. Rep. Kevin Brady, (R-Texas) and Rep. Pat Tiberi (R-Pa.) are pursuing the chairmanship, while Sam Johnson (R-Texas) has been named the interim chairman. Several republicans are interested in filling the slot left open by Rep. Ryan’s departure from the committee.

Cost of ACA Benchmark Plan to Rise Next Year

The price of the benchmark silver plan on the Affordable Care Act’s (ACA) health insurance exchanges will rise 7.5 percent on average next year, according to new data released last week. This is a significant increase over the two percent increase that the plans faced last year. The data shows, however, that changes in premium prices vary drastically across the country. Silver plans are the most popular nationwide – 70 percent of enrollees chose a silver plan last year, and 11 percent of customers chose the benchmark plan. The benchmark silver plans are the second-lowest cost option for consumers among silver plans. They help determine health care premium subsidies for low-income beneficiaries in that market. The data also shows that the number of companies and organizations that plan to offer health insurance on the federal marketplace has remained fairly stable. Consumers will have 47 different plan options on average in 2016, down from 55 in 2015, and will have the choice of plans offered by five different insurance companies, the same as the previous year. The third open enrollment period for the exchanges opened on November 1.

JAMA Study Finds Lack of Specialty Providers in Some Health Plans

As many as 14 percent of health plans sold on the federal government’s health insurance marketplace lack at least one common specialty in their networks, according to a new study published in JAMA last week. The research examined the physician directories of 135 health plans across the 34 states that sold insurance through the federal exchange during the 2015 open enrollment period, and found that 19 plans lacked in-network specialists. The plans lacking specialty access were all located within the same nine states, which the researchers declined to name. Providers in psychiatry, rheumatology, and endocrinology were the specialists most likely to be left out of network. The study also found that while some plans included these specialists in network, providers could be located as far as 50 to 100 miles outside of the most populous city where each plan was offered. Researchers conclude that access to specialists is likely worse in more rural areas. These findings could have significant financial implications for plan enrollees, who might face unexpected costs due to expenses associated with out-of-network doctor visits. Five of the 19 plans do not cover any of the expenses for out-of-network visits, while 11 plans require the patient to pay at least half of the cost of the visit.

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