📈 Axios Vitals: Medicaid spike coming

Plus, ACA preventative care coverage challenged | Wednesday, October 26, 2022

Open in app View in browser   Presented By PhRMA   Axios Vitals By Tina Reed · Oct 26, 2022 🗽 Hello from New York City, where we're hosting Axios BFD, our inaugural dealmaker summit. We'll feature chats with personalities from the business world including with billionaire entrepreneur, "Shark Tank" investor and Cost Plus Drugs co-founder Mark Cuban. Interested in tuning in? Register here to stream the event live. Today's newsletter is 898 words or a 3½-minute read.     1 big thing: States brace for Medicaid spending surge Data: Kaiser Family Foundation; Chart: Madison Dong/Axios Visuals States could start the new year grappling with a surge in Medicaid spending to accompany supply chain pressures, workforce shortages and the effects of inflation, Axios' Maya Goldman reports. The big picture: The end of the COVID-19 public health emergency could result in state Medicaid outlays growing at a rate of 16.3% in fiscal 2023, even with efforts underway to control future program costs, according to a report from the Kaiser Family Foundation. The federal government increased its contribution to the safety-net program during the pandemic in exchange for state pledges to keep enrollees in the program through the crisis. But that additional money could run out as soon as March, if the Biden administration lets the public health emergency expire in January, as many expect. What they're saying: "Inflationary pressures obviously put pressures on our members, but also on the state and on rates, which are really challenging to manage," Amanda Cassel Kraft, who leads Massachusetts' Medicaid program, said during a KFF call on the report. "If the economic picture shifts and we don't have the same level of revenue coming into this state to be able to make additional investments, it creates a real challenge." Indiana is working on a plan to improve transparency and predictability around payment rates for providers, added Allison Taylor, the state's Medicaid director. "It won't solve all the problems but I think it's a nice tool in the toolbox for sustainability." Zoom in: Medicaid is a huge component of state budgets. Because of balanced budget requirements, a surge in program costs can scramble broader revenue and spending projections. Federal actuaries last spring projected per enrollee spending on Medicaid would increase 6.7% in 2022, and 6% in 2023. Yes, but: Most state Medicaid agencies surveyed between June and September weren't expecting state legislators to cut Medicaid budgets. About half of the survey respondents pointed to longer-term financial uncertainty in their states.     2. ACA's preventative care rules under attack Illustration: Sarah Grillo/Axios   Plaintiffs in an Affordable Care Act lawsuit are now asking a federal judge to toss all parts of the law requiring coverage of preventive health services, Axios' Oriana Gonzalez writes. This comes on the heels of last month's ruling on HIV prevention drug coverage. Why it matters: The filing raises the stakes in the closely watched case: If U.S. District Court Judge Reed O'Connor sides with the plaintiffs, millions of Americans could lose coverage for cancer screenings, behavioral counseling, and other recommendations made by the U.S. Preventive Services Task Force. The services are covered for 167.5 million Americans in ACA-compliant private health plans, per a July analysis from the Urban Institute. The court should "set aside" the Preventive Services Task Force's recommendations because the task force was never appointed by Congress, and lacks authority to say which services insurers must cover, the plaintiffs said. Catch up fast: O'Connor ruled last month that the government cannot require a Christian-owned company to cover HIV preventive treatments because it violates their religious rights.     3. Specialists seek Medicare cut reprieve for 2023 Illustration: Natalie Peeples/Axios   Radiologists, nuclear medicine specialists and vascular surgeons are bracing to see if they'll take the worst of Medicare physician payment cuts next year, Axios' Arielle Dreher writes. Why it matters: The Centers for Medicare and Medicaid Services is due to release a final fee schedule as early as this week that's expected to continue phasing in reductions to medical specialties — and likely prompt appeals to Congress for a year-end reprieve. Driving the news: A draft fee schedule released in July put most specialties in line for modest cuts. Infectious disease doctors and internists would buck the trend and receive increases of 5% and 3%, respectively. Interventional radiology could see the deepest cuts, with a 4% cut, while radiology, vascular surgery and nuclear medicine could each see 3% reductions. Yes, but: Physicians are pushing to delay the cuts amid a year-end rush by hospitals, home health agencies and other health providers to head off Medicare payment changes. Lawmakers in a post-election lame-duck session will decide what gets wrapped into a year-end spending deal that's likely to also take up disaster relief, Ukraine aid and a host of other non-health issues. Read the rest.     A message from PhRMA How insured Americans navigate unclear insurance coverage     According to new findings, insured Americans favor policy solutions that improve their ability to navigate and access their care while lowering their out-of-pocket costs. An example: Tackling the barriers introduced by insurers and middlemen like pharmacy benefit managers. Read more.     4. Data du jour: Long COVID's workforce impact Data: NYFed analysis of the Current Population Survey; Chart: Axios Visuals There's been a surge of about 900,000 people with disabilities into the U.S. workforce since 2020, and it's likely because of the increase in Americans with long COVID, according to new research published by the Federal Reserve Bank of New York, Axios' Emily Peck reports. By the numbers: There are 1.7 million more working-age Americans with disabilities now compared to the beginning of 2020 (see the chart below), according to data compiled by Richard Deitz, an economist at the NYFed. "The majority [of the newly disabled] deal with fatigue and brain fog, the hallmarks of long COVID," he writes.     5. Catch up quick President Biden receives his updated COVID-19 booster at the White House on Tuesday. Photo: Anna Moneymaker/Getty Images   💉 President Biden received his updated COVID-19 vaccine on Tuesday while calling on more Americans to do the same. (ABC News) 🏥 Two weeks from Election Day, Democrats are recasting their closing message with more emphasis on the economy and health care — while the GOP is doubling down on messaging on crime and inflation. (Axios) 👎 Just 15% of Republicans have a "great deal" of confidence in scientists to act in the best interest of the American people, according to the Pew Research Center. (Axios) 🌎 Fossil fuel "addiction" is rapidly worsening climate change as the related effects of extreme weather leave 98 million people facing severe food insecurity and heat-related deaths surge, a new report warns. (Axios)     A message from PhRMA Americans want policy reforms that improve their insurance     Did you know 39% of insured Americans say they don't understand what's covered by their insurance? Health insurance coverage should be predictable and transparent, and insured Americans agree. Learn more from PhRMA's latest Patient Experience Survey report.   Thanks for reading, and thanks to senior editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. Please ask your friends and colleagues to sign up. Why stop here? Let's go Pro. Join the thousands of professionals reading Axios Pro: Health Tech Deals to better understand the forces shaping their industry.   Axios thanks our partners for supporting our newsletters. 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