The Council of State Governments hosted policymakers from across the country in June for the first meetings of its two national task forces: Healthy States and The Future of Work.
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In Moda Health Plan v. United States the Supreme Court will decide whether Congress may enact appropriations riders restricting the sources of funding available to pay health insurers for losses incurred that were supposed to be paid per federal law.
The Affordable Care Act’s (ACA) risk corridor program provided that if a health insurance plan participating in the exchange lost money between 2014-2016 it would receive a payment from the federal government based on a formula defined in the statute. If it made money the plan had to pay the federal government based on a formula. The purpose of the program was to induce health insurance companies to offer plans on the exchange despite the fact they didn’t have reliable data to price the plans.
The Government Accountability Office (GAO) identified a particular funding source the federal government could use to make payments. Congress passed appropriations riders for all three years disallowing that funding source to be used to make risk corridor payments.
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As some state legislatures pass laws contradicting Roe v. Wade in the hope the Supreme Court will overturn the 1973 decision, all eyes are on anything the Supreme Court has to say about abortion.
In a per curiam (unauthored) opinion in a case decided without oral argument, Box v. Planned Parenthood, the Supreme Court held that Indiana’s law disallowing fetal remains to be incinerated along with surgical byproducts is constitutional. The Seventh Circuit had invalidated this provision.
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Merck v. Albrecht is a simple issue contained in a long story.
In 2009 in Wyeth v. Levine the Supreme Court held that federal law preempts state law failure to warn claims that a drug manufacturer failed to change a drug label if there is “clear evidence” the Food and Drug Administration (FDA) would not have approved the label change. In Merck v. Albrecht a unanimous Supreme Court held that a judge rather than a jury determines if the FDA would have approved the change.
The federal Food, Drug, and Cosmetic Act (FDCA) provides no federal remedy for unsafe and ineffective drugs but state law may in the form of a failure to warn claim. The FDA allows manufacturers to change warnings on drug labels when newer drug safety information becomes available. The Supreme Court has held if the FDA would not have approved a drug label change, which a state failure to warn law would have required, the FDCA preempts the state law claim.
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When a health consumer receives care outside of an insurer’s network of providers, he or she may receive a surprisingly high medical bill, and face the prospects of paying unexpectedly high out-of-pocket costs.
These situations are not uncommon, and often not the fault of the health consumer — for example, he or she requires immediate emergency care, or an out-of-network provider is part of a larger team of physicians providing complex medical treatment.
As evidenced in recent polling data and new state laws, “surprise billing” has become a widespread concern among health care consumers and policymakers alike. In a poll conducted last year by the Kaiser Family Foundation, two-thirds of Americans said they were either “very worried” or “somewhat worried” about being able to afford their own or a family member’s unexpected medical bills.
The Commonwealth Fund, meanwhile, has been tracking the spread of laws to protect individuals from certain types of “surprise billing.” By the end of 2018, the number of states with such laws had reached 25: nine with comprehensive laws (including Illinois in the Midwest) and 16 with “partial protections” (including Indiana, Iowa and Minnesota).
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Iowa legislators have created a first-of-its-kind system to better meet the mental health needs of children. As part of HF 690, signed into law in May, an appointed state board will be created to oversee this new comprehensive, coordinated system.
Members of the board will include a mix of state executive branch leaders (in health and education), experts in child welfare and mental health, local school leaders, pediatricians and law enforcement. Legislators will serve on the board as non-voting members. Iowa’s new law also spells out the types of “core services” that the system must deliver to children. That list of services includes: early intervention, medication management, outpatient therapy, access to a 24-hour crisis helpline, mobile response teams, and the availability of community-based and residential services to stabilize behavioral health crises in children.
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In December 2018 a federal district court declared the Affordable Care Act (ACA) individual mandate unconstitutional. It also declared the remaining provisions of the act “inseverable,” meaning also invalid. The court didn’t issue a nationwide injunction which would have had the effect of immediately ceasing all aspects of law.
In the district court litigation the Department of Justice (DOJ) didn’t defend the individual mandate. But it did argue that other provisions of the ACA, excluding the guaranteed-issue and community-rating requirements, which were intended to provide affordable health insurance for those with pre-existing conditions, were severable. Now DOJ has informed the Fifth Circuit that it has changed course and agrees with the lower court that the entire ACA was properly invalidated.
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Few if any U.S. states have been hit harder than Ohio by the crushing rise in drug use, abuse and overdose deaths. That state’s rate of overdose deaths was second in the nation in 2017: 46.5 per 100,000. Behind those numbers, too, are tragic stories that have personally touched many Ohio legislators — and helped lead their ongoing search for policy solutions.
“For multiple years, multiple general assemblies, it has been a legislative priority,” says Ohio Sen. Jay Hottinger, a member of the General Assembly since 1995. “If you wrote just a paragraph on each bill, it would be about 17 or 18 pages.”
He was a sponsor of one of Ohio’s most recently passed bills — last year’s SB 119, known as Daniel’s law in honor of a young Ohio man who died from an opioid overdose after years of fighting addiction. Daniel Weidle had found success in his fight through the use of naltrexone (one of the medications federally approved for treatment of opioid-use disorder), but after losing his provider, Daniel got turned down several times in trying to refill his prescription.
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At the same time the federal government has announced a new emphasis on reviewing how well states enforce Medicaid eligibility rules, it has offered a new tool to help states improve accuracy and speed up the eligibility determination process.
In June 2018, the Trump administration announced new initiatives to increase Medicaid program integrity. These initiatives include assuring that states effectively enforce Medicaid beneficiary eligibility rules. The Government Accountability Office (GAO) estimates that improper Medicaid payments totaling $11.3 billion were made in 2017 because of state errors in eligibility determinations.
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In March, ADAPT Pharma, a subsidiary of Emergent BioSolutions and CSG Associate, announced the expansion of its program offering free NARCAN Nasal Spray – the leading community use naloxone – to U.S. high schools and eligible colleges and universities. NARCAN Nasal Spray 4mg is the only FDA-approved, needle-free formulation of naloxone for the emergency treatment of a known or suspected opioid overdose. As part of this effort, ADAPT Pharma will:
• Expand free NARCAN Nasal Spray availability by eliminating the prior 20,000 cartons cap for eligible colleges and universities
• Double the allocation to high schools from one free carton (two 4mg doses) to two free cartons (four 4mg doses)
• Extend the term of the free NARCAN Nasal Spray offer until it is in every high school and eligible college and university in the United States
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