Health Update (April 1)
|Affordable Care Act Litigation
Discussion of the Affordable Care Act (ACA) dominated Washington this week as the Trump administration sided with the district court’s decision in the Texas lawsuit, which ruled that the entire ACA was unconstitutional. A letter from the Department of Justice to the Fifth Circuit Court indicated that the administration “is not urging that any portion of the district court’s judgment be reversed.” The federal government plans to file a brief on the appellees’ behalf. The decision will likely be appealed to the U.S. Supreme Court.
More federal data was released this week regarding ACA open enrollment for 2019. Signups this year only dropped slightly, dropping from 11.8 million to 11.4 million. Roughly 24 percent of consumers in 2019 were new to the federal exchange, compared to 27 percent last year. Average premiums fell from $621 to $612. Public use files containing additional state-by-state data can be found here.
A federal judge has blocked Medicaid work requirements in Kentucky and Arkansas, calling the approval of the work requirements “arbitrary and capricious.” Judge James Boasberg issued his ruling on Wednesday, but the ruling is likely to make its way to the Supreme Court. In a separate ruling, a federal judge also struck down an attempt by the Trump administration to expand association health plans. The judge determined that the Department of Labor rule regarding Association Health Plans “stretches the definition of employer beyond what ERISA’s text and purpose will bear,” and called the final rule an “end-run” around the ACA.
Energy and Commerce News
House Energy and Commerce Committee Democrats sent a letter this week to Department of Health and Human Services (HHS) Secretary Alex Azar and the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma requesting that all ACA marketing and outreach documents be made public. The letter, led by Rep. Lisa Blunt Rochester (D-DE), cited a “steady but dramatic decline” in the number of new ACA enrollees. According to testimony references in the letter, an estimated 2.3 million new enrollments were lost due to the reduction in funding for marketing and outreach. House Democrats have introduced legislation which would restore federal paid marketing efforts for the ACA, which the Trump administration ended in 2017.
The Energy and Commerce Health Subcommittee held its first legislative markup of the 116th Congress. Twelve bills were considered. The first 6 bills were drug pricing bills: The Payment Commission Data Act, BLOCKING Act, Purple Book Continuity Act, and Orange Book Transparency Act all were recommended favorably to the full committee. The remaining 6 bills dealt with the Affordable Care Act, and all activity split along party lines. Democrats offered bills that would counteract steps taken by the Trump administration and HHS, while Republicans attempted to offer amendments that would expand the promotion of short-term, limited duration health plans and association health plans. All bills were reported favorably to the full committee. For further analysis of the markup, please click here.
In his testimony before the Senate Appropriations Subcommittee on the Food and Drug Administration (FDA), Commissioner Scott Gottlieb asked the committee to move forward with new standards for opioid approvals. In his testimony, he highlighted “the potential for evaluating the comparative benefits and risks of new opioids relative to other opioids already on the market.” The FY2020 budget requests an additional $55 million above current funding levels to support the following areas of work: decreasing exposure and preventing new addiction, supporting the treatment of those with opioid use disorder, fostering the development of novel pain treatment therapies, and increasing enforcement and assessing benefit risk.
 Joseph Hunt, Brett Shumate, Martin Totaro. “Letter from DOJ.” U.S. Department of Justice, 25 Mar 2019. https://assets.documentcloud.org/documents/5780853/Letter-From-DOJ.pdf
 “Health Insurance Exchanges 2019 Open Enrollment Report.” Centers for Medicare and Medicaid Services, 25 Mar 2019. https://www.cms.gov/newsroom/fact-sheets/health-insurance-exchanges-2019-open-enrollment-report
 Phil Galewitz. “Federal Judge Again Blocks States’ Work Requirements for Medicaid.” NPR, 27 Mar 2019. https://www.npr.org/sections/health-shots/2019/03/27/707401647/federal-judge-again-blocks-states-work-requirements-for-medicaid
 “Memorandum Opinion.” U.S. District Court for the District of Columbia, 28 Mar 2019. https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2018cv1747-79
 “Blunt Rochester Leads Energy and Commerce Democrats in Calling for Release of Never-Made-Public CMS ACA Marketing Studies and Data.” U.S. House of Representatives, 27 Mar 2019. https://bluntrochester.house.gov/news/documentsingle.aspx?DocumentID=206
 Scott Gottlieb, M.D. “Statement by Commissioner Before Committee on Appropriations.” U.S. Senate, 28 Mar 2019. https://www.appropriations.senate.gov/imo/media/doc/03.28.19–FY20%20Gottlieb%20Testimony.pdf