Congress.
At-home Tests. A couple of House members asked the White House to order Medicare fee-for-Service to pay for at-home Rapid Antigen Tests. File under “know the law.” One of the stranger things about Medicare is that it only pays for tests designed for the diagnosis and treatment of disease. It pays for screening tests but only for five types of cancer. By that definition, it means a physician or other ordering clinician is involved, which would not be the case for an at-home test.
I am sure there is a creative lawyer in there somewhere that might be able to figure it all out, but Medicare beneficiaries are, once again, left behind in the relentless march toward innovation.
Build Back Better. The White House suggested Build Back Better would be resurrected in smaller “chunks.” Still residing in the “go big or go home” camp of federal legislation, Speaker Nancy Pelosi suggested the bill might be smaller, but it would still be a “major piece of legislation."
Press reports suggest the new version would contain some of the drug price negotiation provisions agreed to last year. Other possible survivors are extensions of ACA premium support and filling the Medicaid gap. Not mentioned, probably because there is bipartisan, bicameral agreement, is a long overdue change to the Part D benefit design. When combined with the new DIR fee proposal, we could see some genuine shake-up in the benefit’s economics.
Competitiveness Legislation. Put on ice during the ill-fated Build Back Better and Voting Rights Acts, is a bill to enhance U.S. Competitiveness, is getting a revival in Speaker Pelosi’s latest list of priorities.
Although bipartisan in nature, there is sure to be some complaining from fiscal conservatives and progressives or either don’t like the price tag or think it is hanging on the wrong Christmas Tree.
The bill contains lots of money for research at the National Science Foundation, the Department of Energy and the Department of Defense, but interestingly, not the National Institutes of Health. If you add $250B atop the trillion or so from COVID, the U.S. is going to be very busy on the research front for a decade or more. (ILMN, PACB, TMO)
The White House.
Public Health Emergency. SecHHS Xavier Becerra extended the COVID-19 Public Health Emergency for another 90 days but failed to provide any clarity on when it might end. Reversing two years of operationalizing waivers is not an easy matter. Medicaid plans in particular are concerned about the time and resources needed to handle redeterminations.
We are of the mind that the PHE will expire before the start of states’ fiscal years, which is normally July 1. Our second choice is October 1. Between now and then, the lobbying is going to be stout as the beneficiaries of the blanket Medicare waivers fight to keep their regulatory windfall.
Masks. The Biden White House announced that 400M N95 masks will be made available to all Americans for free in a bid to stem the tide of Omicron spread. This effort will represent more of the same reactive policy decision-making that has characterized the pandemic. As such, these masks should be made available as Omicron is receding naturally.
But I guess we get our victories where we can.
Pending Rules
Other Stuff
4Q 2021 Earnings – Policy Notes
UNH. When UNH lists health benefits second as a company growth driver, you have to consider the possibility that health insurance is turning into something…else. The something else is going to look a lot more like physicians’ practices supported with technology, data, innovation and customer services than an insurance company.
The company also noted near normal levels of commercially insured with government paid utilization depressed due to COVID. Medicare enrollment seems to be holding up, as you would expect for one of the biggest carriers. Expecting Medicaid disenrollment to begin in mid-2022.
ISRG. The company got rocked by expected lower volumes in 1Q. The most noteworthy commentary, I thought, was around the supply chain. While claiming it was not a threat, it also reported an expansion of Capex and significant projects to expand capacity and secure the supply chain. When viewed in the context of INTC’s planned $20B chip factory in Ohio, you begin to appreciate that security and reliability of supplies is going to be much more valuable than price in the coming years.
Union Membership. With health care labor commanding such high prices, it might be easy to expect a return of America’s labor movement. For now, that does not appear to be the case. Membership fell in 2021, probably due to retirements and departures from the workforce.
With the market now driving wage and benefit prices, not union negotiations, it may be a while before the trend reverses itself, if ever.
Upcoming Events.
THE PERSISTENCE OF TESTING PART II HOLX, QDEL, DHR, DGX ET AL Jan 26 @ 10am. (Institutional)
IPOs + SPACs
Quiet week in IPO and SPAC land. Still about $28B in SPAC money laying about looking for a dance partner. Access SPAC spreadsheet here.
Have a great weekend.
Emily Evans
Managing Director – Health Policy
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