Budget Bonanza!

POLICY PERSPECTIVE

Budget Bonanza!

Many were surprised in Washington when domestic spending increases were included in the continuing resolution passed earlier this month. The Bipartisan Budget Act of 2018 provided some spending answers and addressed contentious policies that affect liver patients. While the Act included funding for CHIP and Community Health Centers, and changes to the Medicare Part D and Medicaid Medical Advantage Programs, the repercussions of some these changes have the potential to be detrimental to patients.

Furthermore, the time taken during negotiations has cost vital progress on other liver policy issues, and the department of Health and Human Services faces multiple questions about Medicare and Medicaid coverage. This has led many to question the federal government’s ability to successfully pass legislation that impacts liver patients. In an effort to fill the gap left by federal policy makers, states have stepped up legislative actions to increase insurance access, stabilize markets, and lower costs.

In the Bipartisan Budget Act of 2018 CHIP funding was secured for an additional four years, and Community Health Centers for another two years. The so called “donut hole” that represents Medicare drug coverage gaps is set to be closed in 2019, and drug discounts are set to increase for seniors enrolled in the Medicare Part D program. However, a decreased cost burden on insurance companies could relieve the incentive to keep program costs down. The Medicaid Medical Advantage Program was expanded to include non-medical services like appointment transportation and telehealth, and physician shortages were also targeted by allowing physician assistants to act as attendings in hospice settings. Even though it took a long time to get here, many of these changes provide important security for chronically ill liver patients and other vulnerable groups.

Amidst the squabble lawmakers did succeed in bringing policy to the table with the potential to strongly benefit the highly individualized and specific pathologies of liver patients. Eric Swalwell (D-CA), introduced the Advancing Access to Precision Medicine Act on Feb. 16th, a bill that promotes genetic testing in healthcare. This introduction coincides with questions about whether people who have undergone genetic testing can be denied insurance, emphasizing the importance of a balanced policy approach.  

The lapse of the federal government to address marketplace stabilization has pushed 9 states to take the Affordable Care Act’s (ACA) individual mandate into their own hands, and although ACA enrollment was comparable to last year, enrollment has increased in states that operate their own exchanges. With GOP-led changes leading to an 18.2 percent increase in premium costs for ACA plans, now more than ever has highlighted the state’s role in crafting policies that can benefit or hinder liver patient care.

- Donna Cryer, JD, President & CEO, GLI

OPEN ADVOCACY OPPORTUNITIES

POLICY DEVELOPMENTS AT GLI

NASH Workgroups

GLI’s NASH Council is continuing its efforts with the newly established NASH Council Workgroups. Each of the four workgroups are holding monthly calls to develop action plans and shape programming in specific issue areas.

Public Education and Screening (First Thursday of every month: 12:00pm EST): To increase public understanding of NAFLD and NASH

Clinician Education, Diagnosis, & Management (Second Thursday of every month: 12:00pm EST): To Improve clinician education (pediatric and primary care – specialists) to increase the number of people appropriately diagnosed and connected to care

Patient Education and Support (Third Thursday of every month: 12:00pm EST): To provide actionable information and support for diagnosed patients

Policy (Fourth Thursday of every month: 12:00pm EST): To identify and support policies that facilitate the strategies and objectives of the other working groups (e.g. value and reimbursement)

For more information or to RSVP for a workgroup, contact NASH@globalliver.org.

NHMA “Chronic Disease & Minorities” Congressional Briefing

GLI staff attended the National Hispanic Medical Association (NHMA) Congressional Briefing on February 13, 2018 titled “Chronic Disease & Minorities”. GLI spoke with attendees to raise awareness of the link between cardiovascular disease, genetics, and fatty liver disease, all of which contribute to the high rates of fatty liver disease in the Hispanic/Latino community.

Advanced Advocacy Academy

GLI’s Advanced Advocacy Academy (A3) brought together students and faculty from more than a dozen states to learn what it means to be a liver health advocate. Over the course of two days, patients and caregivers learned about clinical research and development, value frameworks, legislation, healthcare delivery, and more. One patient said, “I appreciated the diversity of topics and the incredibly high caliber of presentations. It definitely exceeded my expectations!” Learn more about A3 and apply to become a member of the A3 Class of 2018!

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STATE ACTION

A bipartisan coalition of Governors from Alaska, Colorado, Nevada, Ohio, and Pennsylvania has released a joint proposal with the aim of decreasing the costs of health care, stabilizing insurance markets and giving states more flexibility to make changes.

Idaho and Iowa regulators said they would permit insurance plans into the marketplace that did not meet ACA guidelines. Blue Cross Blue Shield promptly released plans that broke with the federal law’s stipulations. These actions have surprised legal experts, with some calling them, “crazypants illegal.”

Maryland lawmakers introduced a proposal that seeks to limit prescription drug costs by creating a commission that would determine maximum allowable payments from health plans, pharmacies, and state programs for brand name and patented medications.

Oregon legislation that targets drug transparency passed a first hurdle. It would require drug companies to explain and justify price hikes. The bill will face opposition from manufacturers.

In a shift from the previous administration, Virginia’s Republican-held House of Delegates passed a budget that includes expanding Medicaid for roughly 300,000 uninsured individuals. A showdown is set for the coming weeks as the bill will attempt to make it through an unconvinced Senate.  

Wisconsin Governor Scott Walker, introduced a plan for stabilizing his state’s insurance marketplace through a reinsurance program that was met with both high praise and some skepticism. GLI supports the State’s efforts to decrease premium costs and increase coverage for individuals with preexisting conditions.

HHS NEWS

U.S. Department of Health and Human Services (HHS)

The Department of Health and Human Services approved proposals from Indiana and Kentucky that require work or community engagement to qualify for Medicaid. This decision generated concern for the large cohort of people that depend on the coverage. Like much of the country, Indiana and Kentucky both face an increasing prevalence of liver disease and other medical conditions that disproportionately affect people who have low incomes, are disabled, and those living in rural communities.

HHS also faces questions on lifetime limits for Medicaid. Five states have applied for Medicaid waivers that would limit the amount of time in which an individual can receive benefits. Critics say this would fundamentally change Medicaid’s position as a safety net. HHS director Alex Azar, while promising a thorough review, declined to take a position on whether HHS would approve these waivers.

Finally, following President Trump’s direction, HHS released a proposal that expands access to short-term health insurance plans of less than 12 months. Proponents say these plans will increase healthcare access and competition among plans while opponents argue that these “junk insurance plans” will keep healthy people out of the standard insurance marketplace and drive costs up.

National Cancer Institute (NCI)

NCI published an infographic detailing cancers associated with obesity and overweight. Individuals who are obese or overweight are at greater risk for developing liver cancer.

NGOS

O’Neill Institute for National and Global Health Law

The O’Neill Institute for National and Global Health Law is pleased to announce the start of a new policy focused website on hepatitis C. They aim to provide information on the latest policy actions and and relevant material to the HCV epidemic.

GRANT OPPORTUNITIES

Mechanisms of Disparities in Chronic Liver Diseases and Cancer. Funds available from NIH: $200,000. Application deadlines: April 4, 2018 or April 4, 2019.

Secondary Analyses in Obesity, Diabetes and Digestive and Kidney Diseases (R21 Clinical Trial Optional). Funds Available from NIH: $200,000. Application deadlines: March 16, 2018, July 16, 2018, or November, 2018

Early-Stage Preclinical Validation of Therapeutic Leads for Diseases of Interest to the NIDDK (R01). Funds available from NIH vary with project scope. Application deadlines: March 12, 2018, July 12, 2018, November 12, 2018, and March 12, 2019.

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NAMES TO KNOW

Anne Schuchat, Acting CDC Director: Dr. Schuchat replaced Brenda Fitzgerald who resigned earlier this month.

Policy UpdatesDonna Cryer