October 2015
Feature: Reconciliation Bills Threaten Public Health Infrastructure
Despite continuing political tension, Congress averted a government shutdown by passing a short-term Continuing Resolution (CR) on September 30th, signed by President Obama before budgets for federal agencies were scheduled to deplete. This temporary resolution will extend funding for the majority of federal agencies to continue daily operation until December 11th 2015. The CR did not include any provisions or language related to defunding Planned Parenthood or the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. However, multiple Public Health priorities are being targeted for budget cuts in the reconciliation process.
On September 29th and 30th, the House of Representatives' Ways and Means Committee, Energy and Commerce Committee, and Education and Workforce Committee, separately, passed reconciliation bills. Collectively, these bills will repeal several major factors of the Affordable Care Act, defund Planned Parenthood for one year, and fully cut the Prevention and Public Health fund. This will not only terminate vital heath care services in almost 700 clinics across the nation which specifically serve disadvantaged Americans, but also place an excess service burden on Community Health Centers which will receive redirected funds and patients from the possible dismantling of Planned Parenthood.
All three reconciliation bills will be reviewed and compiled by the House Budget Committee then sent to President Obama, whom has threatened to veto the bill. Congress has roughly two months to collaborate and create a budget for fiscal year 2016, or we face the threat of another government shutdown.
Despite continuing political tension, Congress averted a government shutdown by passing a short-term Continuing Resolution (CR) on September 30th, signed by President Obama before budgets for federal agencies were scheduled to deplete. This temporary resolution will extend funding for the majority of federal agencies to continue daily operation until December 11th 2015. The CR did not include any provisions or language related to defunding Planned Parenthood or the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. However, multiple Public Health priorities are being targeted for budget cuts in the reconciliation process.
On September 29th and 30th, the House of Representatives' Ways and Means Committee, Energy and Commerce Committee, and Education and Workforce Committee, separately, passed reconciliation bills. Collectively, these bills will repeal several major factors of the Affordable Care Act, defund Planned Parenthood for one year, and fully cut the Prevention and Public Health fund. This will not only terminate vital heath care services in almost 700 clinics across the nation which specifically serve disadvantaged Americans, but also place an excess service burden on Community Health Centers which will receive redirected funds and patients from the possible dismantling of Planned Parenthood.
All three reconciliation bills will be reviewed and compiled by the House Budget Committee then sent to President Obama, whom has threatened to veto the bill. Congress has roughly two months to collaborate and create a budget for fiscal year 2016, or we face the threat of another government shutdown.
UPDATE: Medicaid Expansion 2015
In states that have expansion packages, Medicaid coverage will be available for adults based on income alone compared to non-expansion states in which income, household size, disability, family status, and other factors affect eligibility. Expansion of Medicaid now allows people with annual incomes below 138% of the federal poverty level health care coverage regardless of other factors. This population typically consists of low-income able-bodied parents, low-income adults without children, and many low-income individuals with chronic mental illnesses and/or disabilities who struggle to maintain well-paid jobs but did not meet previous disability standards for Medicaid.
According to the Medicaid Enrollment & Spending Growth report released by the Kaiser Commission on Medicaid and the Uninsured, enrollment increased across all 50 states and the District of Columbia by an average 13.8% in the 2015 fiscal year. The 31 states that opted to expand Medicaid under the Affordable Care Act saw an average 18% increase in enrollment and in spending within 2015, the first full year of the expansion. Some financial analysts have equated the Medicaid enrollment spikes to those normally seen in tough economic times.
Find out more about Medicaid Expansion and what it means for you!
In states that have expansion packages, Medicaid coverage will be available for adults based on income alone compared to non-expansion states in which income, household size, disability, family status, and other factors affect eligibility. Expansion of Medicaid now allows people with annual incomes below 138% of the federal poverty level health care coverage regardless of other factors. This population typically consists of low-income able-bodied parents, low-income adults without children, and many low-income individuals with chronic mental illnesses and/or disabilities who struggle to maintain well-paid jobs but did not meet previous disability standards for Medicaid.
According to the Medicaid Enrollment & Spending Growth report released by the Kaiser Commission on Medicaid and the Uninsured, enrollment increased across all 50 states and the District of Columbia by an average 13.8% in the 2015 fiscal year. The 31 states that opted to expand Medicaid under the Affordable Care Act saw an average 18% increase in enrollment and in spending within 2015, the first full year of the expansion. Some financial analysts have equated the Medicaid enrollment spikes to those normally seen in tough economic times.
Find out more about Medicaid Expansion and what it means for you!
EPA Sets New National Air Quality Standard at a Lower Level
The Clean Power Act mandates that the U.S. Environmental Protection Agency (EPA) sets the national air quality standards for ozone pollution. On October 1st, the EPA officially lowered the standard, previously set at 75 parts per billion (ppb) to 70 ppb. The APHA had called for a stricter standard, based on scientific evidence presented by the EPA Integrated Science Assessment, the Health Risk and Exposure Assessment and the Policy Assessment, which showed that 60 ppb would be the ideal level for the health of the population. Nonetheless, this new standard will protect many people, particularly at-risk populations such as children, those with lung diseases including asthma, and older people. Additionally, it will also improve the health of trees, plants and ecosystems, making the outdoors a safer place to be.
The Clean Power Act mandates that the U.S. Environmental Protection Agency (EPA) sets the national air quality standards for ozone pollution. On October 1st, the EPA officially lowered the standard, previously set at 75 parts per billion (ppb) to 70 ppb. The APHA had called for a stricter standard, based on scientific evidence presented by the EPA Integrated Science Assessment, the Health Risk and Exposure Assessment and the Policy Assessment, which showed that 60 ppb would be the ideal level for the health of the population. Nonetheless, this new standard will protect many people, particularly at-risk populations such as children, those with lung diseases including asthma, and older people. Additionally, it will also improve the health of trees, plants and ecosystems, making the outdoors a safer place to be.
Pennsylvania House of Representatives Proposes Bill to Regulate Unfair Practices of PBMs
Pharmacy Benefit Managers (PBMs) are in charge of processing and paying prescription drug claims and act as liaisons between payers and pharmacies. These PBMs manage pharmacy benefits for nearly 95% of Americans. In Pennsylvania, PBMs do not have to register with any state entity. Because of this lack of accountability, there is no standard for determining the maximum allowable costs (MACs) of products and many PBMs engage in unfair auditing practices. MACs establish the unit price for the products sold to pharmacies. Lack of regulation of MACs means that PBMs can set and alter prices for drugs as they choose, resulting in high costs to pharmacies and in turn, patients.
The Pennsylvania House of Representatives has proposed two bills, HB946 and HB947, that would alleviate these disparities. The first bill would require all PBMs to register with the Department of Health and provide pharmacies with how MACs are determined and established to increase accountability. The second bill would create the Pharmacy Audit Integrity Act, which would regulate auditing practices among pharmacies. PBMs would be required to provide sufficient notice to pharmacies prior to audits, and only audits that follow Federal and Commonwealth of Pennsylvania procedures can be conducted. Increased monitoring and strict enforcement of these laws will ensure that drug costs will be lowered to the public, making it more accessible for people to receive the medication they require for temporary and chronic health conditions.
Pharmacy Benefit Managers (PBMs) are in charge of processing and paying prescription drug claims and act as liaisons between payers and pharmacies. These PBMs manage pharmacy benefits for nearly 95% of Americans. In Pennsylvania, PBMs do not have to register with any state entity. Because of this lack of accountability, there is no standard for determining the maximum allowable costs (MACs) of products and many PBMs engage in unfair auditing practices. MACs establish the unit price for the products sold to pharmacies. Lack of regulation of MACs means that PBMs can set and alter prices for drugs as they choose, resulting in high costs to pharmacies and in turn, patients.
The Pennsylvania House of Representatives has proposed two bills, HB946 and HB947, that would alleviate these disparities. The first bill would require all PBMs to register with the Department of Health and provide pharmacies with how MACs are determined and established to increase accountability. The second bill would create the Pharmacy Audit Integrity Act, which would regulate auditing practices among pharmacies. PBMs would be required to provide sufficient notice to pharmacies prior to audits, and only audits that follow Federal and Commonwealth of Pennsylvania procedures can be conducted. Increased monitoring and strict enforcement of these laws will ensure that drug costs will be lowered to the public, making it more accessible for people to receive the medication they require for temporary and chronic health conditions.