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This is the last posting for Healthopolis. Thank you for reading! Please feel free to continue keeping up with congressional health care topics on Roll Call. Also, CQ’s HealthBeat provides a detailed diary of congressional and regulatory developments regarding health care policy-making.
The demand for doctors in 2025 will exceed the number of practicing physicians by 46,100 to 90,400, the trade association for medical colleges predicted Tuesday, downgrading its earlier estimates of a medical labor squeeze.
In 2010, the Association of American Medical Colleges projected a shortfall of 130,600 physicians. The estimates are often used by lobbyists and lawmakers to justify increased federal spending for the training of physicians through Medicare and Medicaid.
The new projections found that primary care physician demand in 2025 will exceed supply by 12,500 to 31,100 physicians, compared to a projected shortfall of 65,800 doctors in the 2010 study. The number of doctors who provide specialty care will fall short by 28,200 to 63,700 physicians. The 2010 study projected a shortfall of 64,800 specialists.
The nation is not currently facing a dire shortage at the moment, according to the report, which assumed that the amount of physicians essentially met the demand on average in 2013 except for primary care and psychiatry.
The new predictions, which were calculated by IHS Inc., considered a range of scenarios that took into account changing health care workforce and national demographic estimates. The estimates were the first comprehensive projections to consider recent changes to care delivery and payment methods. Medicare, Medicaid and private insurers have been moving away from volume-based payments and toward models that pay health care professionals a set fee for managing a patient’s care. The survey also took into account an increased reliance on advanced nurses to provide some medical services that previously had been offered by physicians.
Other factors affecting the new estimates were that the U.S. Census Bureau revised downward its 2025 population projections by about 10.2 million people. The bureau now assumes that the U.S. population will be about 347.3 million in 2025. And the number of physicians completing their training has risen from about 27,000 doctors to about 29,000 annually.
Still, said AAMC President and CEO Darrell G. Kirch, Congress and federal agency officials should take the threat of shortages seriously.
“The doctor shortage is real,” said Kirch. “It’s significant – and it’s particularly serious for the kind of medical care that our aging population is going to need.”
The group said that training a doctor takes between five and 10 years, so the nation should take action now in order to avoid a shortage in a decade. The group is calling for continuing to deliver care in ever-more-efficient ways. The AAMC also wants more federal spending to support graduate medical education, with money to train at least 3,000 more doctors a year
The consumer watchdog group Public Citizen suspects the Food and Drug Administration may be succumbing to influence from the drug industry and slow-walking a proposal that would allow generic drugmakers to update labels if safety problems arise once products are on the market.
CQ’s Georgina Gustin reports the group is cranking up pressure ahead of a March 27 public meeting on the rule change. The group in 2011 petitioned the agency, asking it to propose a rule that would clear the way for generic makers to update labels without agency approval. In 2013, the agency proposed the rule, stating that it expects to release the final rule in December.
Currently, brand name and generic drugs must share the same label information as the original reference drug. But, the group says, when generics take over the market, brand name makers lose incentive to monitor post-market safety, leaving the job up to the generic makers – which lack the authority to update labels without FDA approval.
Days ahead of oral arguments in the Supreme Court case challenging health law insurance subsidies, the consulting firm Avalere Health is projecting that nearly 7.5 million Americans could see premiums increase if justices rule for the plaintiffs and strip aid from consumers in those states that use the federal exchange healthcare.gov.
Eighty-seven percent of federal exchange customers currently receive a subsidy. Avalere said a ruling against the subsidy system means average monthly premium contributions for enrollees could increase between 122 percent and 774 percent, depending on the state. Residents in Alaska and Mississippi would see the highest percentage increases in their premium contributions.
The study assumes consumers do not switch plans following such a ruling. The loss of subsidies would be considered a qualifying event for a special enrollment period, giving consumers the option to buy a cheaper health plan. However, plans could be allowed to terminate contracts with the exchange under certain scenarios, which could reduce coverage offerings, Avalere said.
It may still be three years away, but the health care law’s “Cadillac Tax” is very much on the minds of some powerful Senate Republicans, who are miffed that the IRS is considering excluding some occupations from the levy. The 40 percent excise tax on high-cost health plans was designed to help pay for the law’s coverage expansion while discouraging overuse of generous health benefits and services that drive up medical spending. Unions, with their generous health packages, stood to be among the losers.
So the first IRS notice of rulemaking on how it intends to implement the tax caught the notice of some on the political right this week, by raising the possibility certain high-risk occupations could be excluded from applicable coverage. Senate Finance Chairman Orrin G. Hatch of Utah, along with Judiciary Chairman Charles E. Grassley of Iowa, sent a letter to Treasury Secretary Jacob J. Lew questioning whether the rule could provide carve-outs for occupations they maintain are mostly affiliated with organized labor is not the answer. As CQ’s Melanie Zanona reports, the letter requests that Lew answer how many of the employee categories referred to in the notice are unionized, which other consumers could be considered for an exemption and whether the department is contemplating delaying the regulation in any way.
The tax takes effect in 2018 and is one of the last provisions in the law that will be implemented.
The inspector general of the Health and Human Services Department has devoted a large chunk of its annual work plan to monitoring the implementation of the Affordable Care Act, and this week released a health law oversight plan to focus on fraud, waste and abuse, program value, consumer safety and agency efforts to promote innovation. The IG expects 5-10 reports this year specifically focusing on the ACA.
The top priority will be reviews of insurance exchange operations and examination of exchange infrastructure, management and spending, plus the security of plan enrollment information. The IG also will examine internal federal and state process relating to an expanded Medicaid program, Medicare and Medicaid payment changes and program integrity, plus reviews of public health and preventive health grant programs
Initial reports planned for delivery over the next few months include a review of the accuracy of payments to health plans for premium tax credits and payments to federal insurance exchange contractors. Other reports this year include security reviews of state exchanges and an audit of grants to states to establish exchanges.
When a natural or man-made disaster strikes, a local medical crisis usually follows. Health care facilities and public health agencies normally have disaster plans in place but often need higher level assistance. The Department of Health and Human Services this week released a revised national health security plan.
The goal of the National Health Security Strategy is to “strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies.” The national plan is a fundamental element of federal public health policy and sets specific objectives for the next four years. The strategic objectives are:
This morning the White House released its fiscal 2016 budget proposal. The plan now heads to Congress for assembly into congressional budget blueprints and annual spending bills. Many of the line items in the budget will be easily added to congressional measures. However, congressional Republicans will likely omit the more contentious items and suggest spending restrictions.
In the budget presentation, the administration touted recently announced initiatives on developing precision medicines and a targeted increase in the use of alternative Medicare provider payments as a part of over $1 trillion in total spending allocated for the Department of Health and Human Services. Discretionary spending for HHS, which excludes Medicare and Medicaid, is pegged at $80.2 billion for the upcoming fiscal year.
The budget plan calls for continuing funding for the ongoing implementation of the Affordable Care Act and the operation of state insurance exchanges. The budget also assumes Congress will renew funding prior to Oct. 1 for the state children’s health insurance program (CHIP). The White House suggests an increase in tobacco taxes to pay for the CHIP program extension. The budget also suggests a premium surcharge for new Medicare beneficiaries if they choose supplemental Medicare coverage insurance – or Medigap plans, and renews a call for negotiating prices with drug manufacturers for Medicare prescription drugs. Overall the budget plan seeks $396 billion in Medicare and $13 billion in Medicaid long-term fiscal savings.
Separately, the budget includes increased funding for prescription drug abuse programs and added funding for federal efforts to combat illness and death related to infections caused by antibiotic-resistant bacteria.
A Health Savings Account (HSA) is a tax-exempt account used to pay for health care expenses. Ideally, the account allows an individual to monitor and better manage health care services. A separate Health Reimbursement Arrangement (HRA) is a similar type of account but is employer-funded and reimburses an employee for medical expenses. Together, over $22 billion is invested in the two types of accounts. This week, the Employee Benefit Research Institute reported on details of the two types of plans. The EBRI notes that the overall average account balance for HSAs and HRAs was $2,077 in 2014, up from $1,356 in 2008. The report also notes that accounts with an employer contribution had a higher average balance ($2,403) than those without one ($2,046).
The IRS is offering some relief to taxpayers trying to reconcile their 2014 income tax return with a surplus of advance health insurance premium tax credits. The tax agency on Monday offered relief from late payment and estimated tax fees when a taxpayer discovers that they have a balance due on their 2014 taxes, due to the premium tax credits. Of course, the taxpayer is responsible for the balance due, plus interest if not paid by April 15, but the waiver eliminates the additional penalties for failing to plan ahead for the excess tax. The waiver of the poor planning penalties only applies to the 2014 tax year.
President Obama this evening delivers the annual State of the Union address. The White House has not signaled that the address will feature major health care initiatives but the speech will likely highlight recent health care accomplishments and progress on the implementation of the health care overhaul law. The list of invited White House special guests includes the chief executive of CVS Health, a drug store chain that recently stopped selling cigarettes. Also on the guest list is a physician who has recently returned from assisting in the effort to combat the Ebola virus outbreak in West Africa.
Later this week, a House committee holds a two-day hearing to examine options on overhauling the Medicare physician payment formula, which is due for an extension or a complete overhaul prior to a March 31 deadline. A Senate committee examines employer-based health insurance and the health care overhaul law’s definition of a full-time worker. A House-passed measure (HR 30) adjusting the workweek threshold for insurance coverage is awaiting possible Senate action. Also this week, the House will vote on a measure (HR 36) banning abortions after a 20-week threshold. The vote coincides with an anti-abortion rally, which is held in Washington, DC each year on Jan. 22.
In December, the Indian Health Service (IHS) issued a proposed rule seeking to align IHS physician payments with established payment rates for the Medicare program. The objective of the rule is to free up funds for the continuously cash-strapped health service since IHS physician payment rates in various areas of the country are often higher than the Medicare rates. Today, bowing to a request for more time to comment of the request, the agency has extended the period for public comments on the proposed rule from Jan. 20 to Feb. 4.
Since the start of the year, the House has been quick to pass legislation that parse elements of the Affordable Care Act. On Monday, lawmakers advanced a bill (HR 33) exempting volunteer emergency services workers from employer insurance coverage requirements. Last week, the House passed a measure culling the employer mandate to aid in the hiring of veterans (HR 22) and changed the workweek threshold of a full-time employee (HR 30). Waiting in the wings, are recently prepared House and Senate bills seeking to repeal the health law’s medical device excise tax (HR 160 and S 149).
The medical device tax was inserted into the Affordable Care Act primarily to raise money to fund other parts of the law. Repealing the health law’s imposition of a 2.3 percent excise tax on medical devices has long fostered some Democratic lawmaker interest, particularly from states and districts that are home to major medical device manufactures. However, the IRS has struggled to collect the medical device tax and Congress will be challenged to recoup lost expected funding. Separately, the Congressional Research Service weighed in last year with an economic analysis of the tax noting that an excise levy is not an efficient way to raise revenue and most of the impact of the tax will fall on consumers. The report also notes the tax will likely have a minimal impact increasing overall health spending.
The widespread use of antibiotics is reportedly causing bacteria to develop resistance to current antibiotic drugs. The topic is a perennial concern for lawmakers and CQ Roll Call reported this week that an effort to speed the development of new antibiotics will likely be included in an upcoming broader medical research overhaul measure.
Meanwhile, The New York Times this week reported on a new method of producing antibiotics by extracting bacteria from the soil. A recent study reported that some of the newly discovered antibiotics have been found effective in early tests. One of the dirt-based antibiotics was found in the soil in the state of Maine.
Congress this week assembled for a new session and quickly jumped into measures addressing the Affordable Care Act. The House on Thursday, in its first contentious vote, passed a bill that adjusts the workweek definition of an employee subject to required employer-offered health insurance coverage. The bill seeks to adjust the definition of a full-time employee from 30 hours to 40 hours. The House has weighed in on the matter before, but this year the Republican-led Senate is expected to also consider the bill.
Meanwhile, lawmakers filled the new-bill hopper this week with their most pressing legislative objectives. Several proposals urge the repeal of the health care overhaul law, but many address specific elements such as an opt-out requirement and a renewed effort to repeal the law’s medical device excise tax.