Friday, November 18, 2016


Time marches on. reports that House and Senate leadership plan to pass a continuing resolution funding the federal government through March 31 to allow the incoming Trump administration an opportunity to weigh in on spending for the last six months of the current federal fiscal year.  The current continuing resolution expires on December 9.

Walt Francis has issued another report criticizing the FEHBP elements of the postal reform bill pending before Congress, H.R. 5714. In order to place the report in perspective, readers must understand that over a decade ago Congress began to require the Postal Service to pre-fund its retiree coverage.  The Postal Service in order to control this cost is reasonably demanding that its retiree coverage be fully integrated with Medicare.  This requires a change in the law.  Because the bill would preserve one of the most important pieces of the FEHBA -- single risk pools per plan option -- reducing Medicare eligible annuitant costs will lower premiums for the entire population.  The Medicare law allows FEHB plans to integrate their prescription drug benefits with Medicare Part D.  The postal reform bill would require that this EGWP feature be added to the Postal Service health plans established by the law.  Mr. Francis explains:
Part D EGWP participation would apply to all postal annuitants over age 65, virtually none of whom are currently enrolled in Medicare Part D. All FEHBP drug benefits are at least as generous as those in Part D, and most are better, so almost no federal annuitants currently enroll in Part D. Moreover, the Office of Personnel Management (OPM), the agency that administers the FEHBP, would dictate EGWP designs. One might assume that under OPM-approved EGWP plans, drug benefits would remain unchanged, with no additional cost to enrollees, but OPM could nonetheless decide to force changes in drug benefits and/or premiums.
The FEHBlog wants to point out with an EGWP which are common in the private sector the plan pays the Medicare Part D premium and the plan can wrap its prescription drug benefits around the Medicare Part D benefits.

Mr. Francis is correct that the bill as currently drafted would place OPM in charge of the EGWP.  The Medicare law does not dictate this outcome, and hopefully this feature of the bill will be eliminated as it is refined before passage.  The FEHB plan carrier who hold the insurance risk must be able to manage the full suite of benefits.  

The Medicare integration provisions of H.R. 5714 must be considered and approved by the House Ways and Means Committee.  There is now a CBO report on the bill which allows that consideration to occur. (No such hearing currently is scheduled.) Because Congress is anxious to get out of town after this tumultuous year, it's likely that postal reform will be punted into 2017.

Here's a head scratcher.  Kaiser Health News is reporting
Even if there’s a retail health clinic less than a 10-minute drive away, consumers are just as likely to go to the emergency department for low-level problems like bronchitis or urinary tract infections, a recent study found. 
“Our results aren’t necessarily the wooden stake in the heart of retail clinics,” said Grant Martsolf, a policy researcher at the Rand Corp. and the lead author of the study, which appeared online this month in the Annals of Emergency Medicine. Retail clinics can play an important role in providing easier, more timely access to primary care services, Martsolf said. But the study results suggest that clinics aren’t the solution that policy experts have been hoping for to reduce expensive but unnecessary emergency department visits, he said.
Old habits die hard evidently.

No comments: