Latest & Greatest
Supreme Court Votes to
Uphold Tax Subsidies Under
the Affordable Care Act
In a 6-3 ruling, the Supreme Court voted to uphold the
tax subsidies outlined under the Patient Protection and
Affordable Care Act (ACA). Justices John Roberts, Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer,
Sonia Sotomayor, and Elena Kagen voted in favor of the
subsidies.
The King v. Burwell ruling preserves tax benefits for
nearly 6.4 million Americans in 34 states, according to
the Department of Health & Human Services. In addition, 85 percent of those who bought insurance through
the federal health-care exchange qualified for subsidies
averaging $272 per month.
The trial centered on arguments that, based on the
language in the ACA, tax credits were eligible only to
low- and middle-income adults living in states with
state-operated exchanges – not to those who purchased
health insurances through the federally run exchanges.
Though the petitioner in the case argued that the
language was ambiguous, Chief Justice Roberts noted
in the Supreme Court’s majority opinion decision that
the plaintiff ’s interpretation of the law “would destabilize the individual insurance market in any state with a
Federal Exchange, and likely create the very ‘death spirals’
that Congress des igned the Act to avoid.” Of the court’s
majority opinion, Chief Justice Roberts wrote, “Congress
passed the [ACA] to improve health insurance markets,
not to destroy them.”
President Obama spoke out in support of the court’s
recent ruling, saying, “Today is a victory for hardwork-
ing Americans all across this country whose lives will
continue to become more secure in a changing economy
because of this law,” subsequently proclaiming that, “the
[ACA] is here to stay.”
Not surprisingly, the ruling was unpopular with
the many who opposed the ACA, with Senate Majority
Leader Mitch McConnell commenting, “Today’s ruling
[will not] change the skyrocketing costs of [copayments],
deductibles, and premiums that have hit in the last few
years.”
CMS Updates Medicare Physician Fee Schedule,
Details MACRA Quality Reporting
In early July, Medicare released the first
proposed physician fee schedule for the
2016 calendar year via the Medicare
Access and Children’s Health Insurance
Program Reauthorization Act (MACRA)
of 2015. This is the first update to the
physician fee schedule since the April
repeal of the Sustainable Growth Rate.
The payment schedule focuses on the
shift to patient-centered care based on
quality and health outcomes.
“[The Centers for Medicare and
Medicaid Services] is building on the
important work of Congress to shift
the Medicare program toward a system
that rewards physicians for providing
high-quality care,” said Andy Slavitt,
acting administrator for the Centers of
Medicare and Medicaid Services (CMS),
in a press release from the organization. “CMS and Congress are working
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ASH Clinical News
together to achieve a better Medicare
payment system for physicians and the
American people.”
Notable elements of the rule include:
• A proposal to pay for advanced care
planning services
• A request for information on how
Medicare could pay for interprofessional collaboration such as consultation between two physicians
• A framework for payment of biosimilar drugs
• Plans for transition from the
value-based modifier pay-for-performance to the more comprehensive program created in legislation
earlier this year
This was the second lawsuit regarding the constitutionality of the ACA to reach the country’s highest court,
following the 2012 National Federation of Independent
Business v. Sebelius case, which found that the individual
mandate portion of the law that required Americans to
buy health insurance was indeed constitutional. Additional lawsuits are still pending against the ACA, though
many proponents of the law hope that this recent ruling
will deter judges from advancing such cases.
Sources: Kaiser Health News; The New York Times
In addition, physicians will see a 0.5
percent overall increase in Medicare
reimbursement, though each specialty
will be impacted differently; for example, pathologists will see an 8 percent
increase, while gastroenterologists and
oncologists face 5 percent and 3 percent
pay cuts, respectively. In the current
proposed rule, hematologists will experience no change in reimbursement.
The CMS proposed rule also includes modifications to the Physician
Quality Reporting System (PQRS):
“CMS proposes to make changes to
the PQRS measure set to add measures
where gaps exist, as well as eliminate
measures that are topped out, duplicative, or are being replaced with a more
robust measure.”
CMS is seeking comment from
stakeholders and the public on MACRA,
specifically on the new merit-based
incentive payment system. A final rule
will be published this fall.
Source: CMS press release
House of Representatives Passes Bill to
Speed Up U.S. Drug
Approvals
On July 10, 2015, the 21st Century Cures
Act (HR6) overwhelmingly passed
through the House of Representatives
with a vote of 344-77. The bill aims to
make the drug approval process less
burdensome, as well as adding funding
of $8.75 billion to the National Institutes
of Health (NIH) over the next five years
through scientific grants; this is the largest
increase the country has seen in a decade.
“This bill is about making sure our
laws, regulations, and resources keep
pace with scientific advances, said House
Energy and Commerce Committee Chairman Fred Upton (R-MI) in a statement.
Representative Joseph Kennedy, III (DMA), who cosponsored the bill, added:
“There are potential treatments out there
August 2015