Weekend update

Congress remains in session this week. Both of the Committees with responsibility for OPM and FEHBP oversight will be holding business meetings. The House Oversight and Government Reform Committee will meet on Tuesday, and the Senate Homeland Security and Governmental Affairs Committee will meet the following day.

The Senate Committee in the course of its meeting will consider the President's nomination of Michael Mulvaney to be director of the Office of Management and Budget, a key position in the federal bureaucracy. Mr. Mulvaney is a Republican Congressman from South Carolina.

In a bit of good news, the Wall Street Journal reports that big prescription drug manufacturers like Merck have begun to publicize their pricing.

Merck & Co. published a list of average price increases across its drug portfolio on Friday. Merck raised its gross price an average of 9.6%. After rebates, discounts, and product returns, however, Merck realized an increase of just 5.5% on a net basis.
Other drugmakers plan to follow suit. Johnson & Johnson said it would publish a similar list next month. Executives at AbbVie and Allergan, meanwhile, have pledged to limit both the number and the magnitude of gross price increases going forward this year. 

[While Merck's net increase is above the rate of inflation,] the Merck report is a meaningful step forward in improving pricing transparency. Drug companies have long argued that gross prices don’t reflect the revenue that actually accrues to the manufacturer. That statement has always been accurate. Other members of the pharmaceuticals supply chain, like pharmacy-benefit managers and drug wholesalers, also benefit from regular price hikes. The industry’s argument hasn’t clearly resonated with the general public or politicians. 

For what it's worth, the point has resonated with the FEHBlog.

Speaking of prescription drugs, Fierce Healthcare reports on five steps that health plans can take to help control opioid abuse.  The study can be found here.  The report adds that

[I]nsurers have already taken steps to mitigate the opioid crisis. Cigna, for example, eliminated prior authorization rules that can lead to delays for patients receiving MAT. And last week, Anthem announced that it set a goal of reducing the amount of opioids dispensed among its members by 30% by the end of 2019.

TGIF

Here's a link to the Week in Congress's report on this week's activities on Capitol Hill.  The FEHBlog noticed on the House Rules Committee website that the House of Representatives is beginning the process of striking down certain recent Obama administration regulations, such as the Federal Acquisition Regulation's Fair Pay and Safe Workplaces rule, under the Congressional Review Act.  (A federal judge struck down the more onerous parts of that rul  at the end of December.) Kim Strassel of the Wall Street wrote a column today discussing the intriguing features of this underutilized law.

The Wall Street Journal also reported today that "Rep. Diane Black (R., Tenn.), the interim chairwoman of the House Budget Committee, told reporters Wednesday she expected the legislation repealing [and replacing] the health-care law would come to the House floor by late February or early March."  Reuters tells us about insurance company efforts to shape healthcare re-reform.

Healthcare Dive reports that according to an American Well survey 20% of us are willing to switch primary care doctors in order to visit their doctor on a telehealth service. Not surprisingly,

Most willing to switch doctors were parents of children under age 18 and 35 to 44 year olds, the survey shows. Moreover, 79% of consumers caring for an ill or aging family member felt video services would be helpful.

The FEHBlog is growing weary of the Chicken Littleism that abounds in the press over the impending ACA repeal. Modern Healthcare writes about how the repeal will bring an end to mental health care.  That's ridiculous. To begin with, the federal mental health and substance abuse parity act was part of the Obama stimulus law enacted in early 2009, not the ACA which was enacted the following year. The 21st Century Cures Act which Congress passed in December 2016 supports the Obama Administration's rule implementing the law.  Mental health coverage will not be reduced. In any event, I think that insurers and employers now understand the importance of mental health and substance abuse coverage. The ACA repeal will not occur in a vacuum.

Mid-week update

The FEHBlog was pleased to read in Fierce Healthcare that there's at least one other consultant who is optimistic about healthcare re-reform.

Rita Numerof, president of healthcare management consulting firm Numerof & Associates, who describes herself as a longtime proponent for healthcare reform, isn’t convinced that the fear, angst and worst-case scenarios bandied about in the last few days are based on facts. She suggests Americans take a deep breath and see what unfolds. “We didn’t get here overnight,” Numerof told FierceHealthcare in an exclusive interview, “and it won’t be gone overnight. No one has said you are going to lose coverage. The fear-mongering is not helpful.” * * * 

Instead of the individual mandate to buy a “particular kind of insurance with particular provisions at a narrow price range,” she believes Trump’s action will set in motion an opportunity for real consumer choice. The limits of the insurance coverage within the current exchanges don’t mesh with society’s view that “people should not be forced to buy things they don’t want and don’t need.”

The FEHBlog heartily agrees with Ms. Numerof. One size does not fit all.

Federal News Radio reports that

After years of pressuring from the Postal Service and a series of stalled bipartisan bills, the House Oversight and Government Reform Committee has made postal reform a top priority for this Congress. Rep. Jason Chaffetz (R-Utah), the committee’s chairman, told lawmakers Tuesday at a goal-setting organizational meeting that last year’s efforts served as a “good starting point” for getting a postal reform bill on President Donald Trump’s desk within the next two years.

The FEHBlog will be following this effort, which includes a Postal Service Health Program within the FEHBP.  Here's a link to a video recording of the meeting. Earlier this week, Chairman Chaffetz announced that Rep. Mark Meadows (NC) will chair the government operations subcommittee whose jurisdiction includes our beloved FEHBP.

And ruh roh, the American Medical Association and the American Hospital Association have joined forces in an effort to reform health plan pre-authorization practices according to this Modern Healthcare report.  The groups have created 21 pre-authorization principles which seek to place the focus on clinical care rather than cost.  (Here's a link to the AMA's announcement.) The FEHBlog didn't realize that those factors could be separated in this case. As the FEHBlog understands it, prior authorization exists to make sure that clinical evidence supports a more expensive treatment.

And another thing

This morning, the federal judge who heard the Aetna-Humana merger case, John Bates, issued a 160 page opinion blocking the merger based on federal antitrust law.  Aetna and Humana are major players in the Medicare Advantage program.  Aetna and Humana argued that Medicare is a unified market. The judge disagreed finding that traditional Medicare and Medicare Advantage markets are separate markets for antitrust law purposes. That appears to be the linchpin in the decision. 

Here's a Reuter's article on the court decision. 

"We're reviewing the opinion now and giving serious consideration to an appeal after putting forward a compelling case," Aetna spokesman T.J. Crawford said. Humana did not respond to a request for comment.  Humana stands to receive a $1 billion breakup fee from Aetna should the deal be abandoned.
Jeffrey Jacobovitz, a litigator at law firm Arnall Golden Gregory LLP, said that appeals at the D.C. Circuit succeed about one-third of the time and can take a year to resolve. He added that it would be difficult, though not impossible, for Aetna to wait for Trump's new antitrust enforcers to be named and then strike a settlement to save the merger, perhaps by offering to divest more assets.

Aetna and Humana also sponsor FEHB plans.  As noted yesterday,  Judge Amy Berman Jackson's decision in the Anthem - Cigna merger case is expected this week.

Govexec.com provided details on the President's executive order issued today that imposes a temporary hiring freeze on federal agencies.  "The memorandum gives the directors of the Office of Management and Budget (Trump’s pick, Rep. Mick Mulvaney, R-S.C., will face confirmation hearings Tuesday) and the Office of Personnel Management (Trump has yet to name an OPM leader) 90 days to come with a “long-term plan to reduce the size of the federal government through attrition.” Once that plan is implemented, the hiring freeze will expire."

Weekend Update

Following up on Friday's post about the new executive order, here are links to that order and a related Wall Street Journal article attempting to read the tea leaves.  Also on Friday, the President's chief of staff issued a regulatory freeze memorandum.  The Washington Post explains that

The memo states that federal agencies cannot send new regulations to the Office of the Federal Register — a key step in the finalization of new rules — until Trump’s administration has leaders in place to approve what these agencies are doing. Moreover, it also states that regulations that have been sent to the office but have not yet made it into the published register need to be withdrawn. The Obama administration issued a similar memorandum right after the president took office in 2009.

There are no FEHBP related rules that fall into this category.

Congress continues in session this week on Capitol Hill.  Both Houses are getting organized.  The Senate is busy with Presidential nominations and several pieces of legislation that the House already has sent over for consideration.

Several press organizations including Fierce Healthcare report that U.S. District Judge Amy Berman Jackson is expected to issue her final ruling in the government's anti-trust case to block the Anthem-Cigna merger.  The prognosticators predict a government victory.  Anthem is already engaged in contingency planning for an appeal.  U.S. District Judge John Bates also is expected to rule this month in the government's anti-trust case to block the Aetna-Humana merger.

Last week, HHS's Office for Civil Rights announced its last HIPAA compliance scalp for the Obama Administration era.  The change in administration's is not expected to affect this agency's HIPAA enforcement approach.

Finally here are some innovation tidbits:

• TechCrunch reports on a high tech approach to concierge medicine recently opened in San Francisco under the trade name Forward.   According to the article, 

One might be tempted to compare Forward to something like One Medical, a startup with a series of well-branded medical offices popular in the Bay Area. But Forward goes far and above with a state-of-the-art 3,500 square foot office equipped with six exam rooms, the latest medical instruments and an onsite lab for testing within minutes.

• Health Payer Intelligence reports about "UnitedHealthcare’s bundled payment model for hip, knee and back surgery [which] is called The Spine and Joint Solution. The health plan under this bundled payment model is now available to employers around the country. UnitedHealthcare has partnered with hospitals and post-acute care facilities that have experience with spine and joint replacement surgeries and show few complications.

• Finally, Minnesota Public Radio News reports that 

A big Minnesota hospital system is joining forces with a major health insurance company — Allina Health on Wednesday announced a joint venture with Aetna.

CEO Penny Wheeler said the partnership with Aetna is meant to reduce the financial burden on patients, mainly by keeping them from getting sick in the first place. She said coordinating patient data with the insurer is the key.

"For example, you have a frail elderly patient with diabetes who's unable to get a prescription filled. And by combining information with our side of the organization — the clinical information — with the claims information from the insurance side, we can intervene and help support them in getting the medication they have so they avoid trouble," she said.

Wheeler said Allina will remain a nonprofit system, and the combined venture is not a merger, but rather a separate for-profit company.

New Sheriff in Town

The Hill reports tonight that

President Trump on Friday signed an executive order directing federal agencies to “ease the burden of ObamaCare."

Trump signed the order in front of reporters at the Resolute Desk in the Oval Office, one of his first official acts as president.

The order did not direct any specific actions, but instead gave broad authority to the Department of Health and Human Services and other agencies to take actions available to them under the law to ease regulatory requirements from ObamaCare.

It pushes agencies to target provisions that impose a "fiscal burden" on a state or a "cost" or "regulatory burden" on individuals or businesses. 

(The FEHBlog has not yet been able to find a copy of the executive order online.)  The entire law imposes a regulatory burden on individuals and states.  It will be interesting to see how quickly this executive order is implemented at OPM.  

 

Farewell, Ms. Cobert

With little fanfare, OPM today switched the acting Director bio from Beth Cobert, who as a political appointee rode into the sunset, to Kathleen McGettigan. Ms. McGettigan's bio on opm.gov explains that

Kathleen McGettigan was named Acting Director of the Office of Personnel Management (OPM) on January 19, 2017. She has an extensive understanding of both the private and public sector, having spent over 25 years dedicated to the Federal service at OPM and 20 years in private sector financial management.

Most recently Ms. McGettigan served as the Chief Management Officer (CMO) at OPM, providing overall organizational insight, analysis and strategic planning to effectively meet programmatic and financial goals of the agency.

 (Of course, OPM has not had a deputy director for an Ice Age.)  Best wishes, Ms. Cobert, and good luck, Ms. McGettigan.

Crazy week

The FEHBlog was visiting a client for most of the day today, and he returned to his office near 14th and K St around 3 pm.  It was pandemonium with pro-Trump and anti-Trump agitators. (A small anti-Trum rally marched down the middle of K Street during rush hour.)  The FEHBlog is glad that he is staying home in Bethesda on Friday.

The FEHBlog has been reflecting over the press-created uproar over impending changes to the Affordable Care Act. Let me share some thinking.

The FEHB Program is part of the large group market.  In 2010 when the ACA was enacted there were no serious problems with that market.  The small group market in which the FEHBlog participates was a little messy and the individual market was a mess.

Note of course that health insurance premiums in the large group market are 100% exempt to the managers and employees; those premiums are 50% taxable to owners in the small group market and are 100% taxable to people in the individal market (if they fall outside the ACA's income limits (four times the poverty line).  This fundamental problem, which dates back to the World War II price control regime, never has been fixed.  Congress should level the tax playing field for all Americans.

But rather than playing small ball with the small group and individual markets, the Democratic Congress with the support of President Obama supported an unnecessary and massive across the board fix. As a result, the large group market, including the FEHBP, is overburdened with regulation, subjected to price regulation, and  forced, with OPM's support in the case of the FEHBP, to provide one size fits all coverage including 100% reimbursement of many otherwise low priced items (which in turn significantly raises the cost of those items.  Health insurance should not be treated as a price support for health care services and products.).

The ACA's changes such as the creation of the marketplace did not lower premiums in the small group and individual markets.  Consequently, in the FEHBlog's view, give the Republican Congress, hopefully in consultation with the Democrat minority in Congress and of course the new President, a chance to fix the small group and individual markets. But leave the FEHBP and other large group plans out of that legal fix.

With respect to the individual and small group markets, the FEHBlog supports the idea of the subsidized marketplace but with more consumer choice in benefit design, much less price regulation, and as much frill removal as possible (e.g, kill the patient centered outcomes research institute).  He also supports expansion of government supported community health centers which can provide direct primary care in lower and even middle income communities.

It's worth adding that the FEHBP is a group insurance market which in its over 55 year history has never imposed pre-existing conditions or late enrollment penalties like Medicare Part B.  Perhaps the newly designed individual marketplace should use a late enrollment penalty instead of the individual mandate. The bottom line though is that the marketplace needs more time to mature.

King Day Weekend Update

Happy King Day Weekend!

It's the last week of the Obama administration.  President-elect Trump will be sworn in at noon on Friday January 20. Congress will be in session briefly this week. Here is a link to The Week in Congress's report on last week's activities on Capitol Hill.

No news yet on the President-elect's choice for OPM Director in his administration.  President Obama nominated his first OPM director,  John Berry on March 23, 2009. So if precedent is any guide, it may be a few weeks yet before we learn who will be the next OPM leader.  Govexec.com reports on OPM guidance issued last week to allow the Trump administration "to place nominees into agency positions while they await [Senate] confirmation."

Yesterday's Wall Street Journal (the "FEHBlog's favorite newspaper) published an essay on a structured approach to treating the Nation's opioid epidemic, which is worth reading.

TGIF

Ah, the second week of the NFL playoffs. Hopefully this week's games will be better than last week's. Of course, the stakes are higher.

Govexec.com published an article on OPM's 2018 call letter.  It would be interesting if OPM just issued a one paragraph call letter telling plans to submit proposals by May 31 and then see how creative the carriers can be thanks to a pretty vibrant market.

Yesterday the ACA regulators proved me wrong by issuing ACA FAQ 37 which principally concerns arcane aspects of health reimbursement accounts.  Perhaps they can reach FAQ 40 by next Thursday.

In that regard, the Wall Street Journal reports that this afternoon the House of Representatives

took its first procedural step toward repealing the Affordable Care Act, passing a budget that directs lawmakers to start drafting legislation to dismantle much of the 2010 health care law.  Already approved by the Senate, the budget resolution passed the House on a 227-198 vote. Nine Republicans voted with 189 Democrats to oppose the budget. No Democrats voted for it.  The measure will start the substantive work on measures to repeal portions of the health law, instructing two House and two Senate committees to come up with proposals by Jan. 27.

The Senate committees named in the resolution are Finance and Health, Education, Labor and Pensions, and the named House committees are Ways and Means and Energy and Commerce. The full resolution text is available here if you are interested.

Mid-week update

Govexec.com interviewed House Oversight and Government Reform Committee Chairman Jason Chaffetz in Monday's edition.  Mr. Chaffetz explained that his focus of attention will shift from oversight to reform in this session of Congress as he has an opportunity to enact some legislation with  both the Executive and Legislative Branches in the hands of his party for at least the next two years. The FEHBlog was interested to read that "Chaffetz will meet with the cosponsors of his bill to reform the U.S. Postal Service, including [Rep.] Connolly, this week and expects to reintroduce a bill very similar to the one that cleared the committee last year." The FEHBlog was surprised to read that "The main point of contention is a provision to require all postal retirees to enroll in Medicare as their primary health insurance provider."

The Postal Service has been pushing for full Medicare integration for at least five years in order to significantly reduce the burden of pre-funding post-retirement coverage for its retirees. The FEHBlog looks forward to reading the new version of the bill which was HR 5714 in the last Congress.

Also on Monday, the OPM Inspector General made public a December 2016 management report on the Multi-State Plan Program.  This program, which OPM administers, was intended to add more plans to the ACA marketplace.  The Inspector General explains why that effort has run into roadblocks. He overlooks perhaps the key roadblock -- the difficulty of making a profit in the ACA marketplaces.

Yesterday, the Obama Administration's ACA regulators issued perhaps their final ACA FAQ which is no. 35 -- well less than the number of Super Bowls.  This FAQ responds to a U.S. Supreme Court for a regulatory compromise that would resolve religious institution objections to the Administration's birth control coverage mandate. The ACA regulators kicked the can down the road to the new Administration by refusing to compromise.

The Labor Department's Employee Benefits Security Administration which enforces ERISA issued an FY 2016 Fact Sheet on enforcement of the mental health parity law.  Also the ACA regulators posted public comments on a series of related mental health parity questions raised by ACA FAQ 34 last year. Those questions concerned how to educate consumers and health plans about the mental health parity rule's complex non-quantitative treatment limitation requirements.  Title XIII of the recent 21st Century Cures Act addresses the same issue with a requirement that the regulators issue guidance on NQTL requirements.

Modern Healthcare reported earlier this week that

In an effort to fulfill its mission to expand its provider footprint to serve about two-thirds of the U.S. population, OptumCare has agreed to acquire Surgical Care Affiliates for about $2.3 billion in a cash and stock deal.  Deerfield, Ill.-based SCA owns or operates 190 ambulatory surgery centers and surgical hospitals, most as joint ventures with physicians and health systems. The company says SCA and its affiliates serve approximately 1 million patients per year in more than 30 states. In 2015, it had operating revenue of around $1.1 billion.

OptumCare is an arm of the largest health insurer in the U.S., United Health. The article explains

UnitedHealth has said Optum aims to provide primary care and ambulatory services in 75 markets, representing about two-thirds of the U.S. population. Over the past year, Optum has purchased physician practices around the country. It also acquired urgent-care provider, MedExpress. In 2014, Optum agreed to acquire MedSynergies, a physician practice consulting firm, and care-monitoring company Alere Health for $600 million.

Interesting.

On the HIPAA privacy and security front, the HHS Office for Civil Rights announced another scalp resulting from a health plan's failure to give prompt notice of a protected health information data breach. $475,000 was required to settle the matter.  OCR also created a new FAQ which clarifies the circumstances under which doctors, hospitals, and health plans can share information with a person who is not married to the patient or is not one of the patient's relatives.

Finally, an op-ed in the Wall Street Journal this week provided some background on the continuing problem of lack of interoperable electronic medical records, which of course the FEHBlog's major pet peeve. The Obama Administration missed the boat by failing to include interoperability requirements in the EMR standards that were created as part of the government's $30 billion investment.  The op-ed writer explains that the largest EMR vendor is refusing to ally with the smaller vendors to resolve the problem. The op-ed writer suggests.

The real incentive is insurers paying for this data, and they are figuring out that early detection is worth it. It’s a lot cheaper to find a disease before it turns into expensive chronic care for heart disease or cancer. The machine learning output might be: “You may have pre-Stage 1 cancer in your pancreas, but no worries—we can zap it out for you.”

The article is worth reading.

The World Turned Upside Down? Call letter in January?

OPM issued this afternoon its call letter for 2018 FEHB benefit and rate proposals which are due at the end of May. Here's a link to that letter.

Last year, the call letter came out in February which now holds the World's record for second speediest call letter issuance.  Interestingly, in 2009, the outgoing George W. Bush administration's OPM did not preempt the incoming Obama administration's OPM by issuing the call letter before January 20, 2009. The 2010 call letter came out rather late on April 20, 2009.

Weekend update

The 115th Congress enters its second week of life this coming week. Here's a link to the Week in Congress's report on last week's activities on Capitol Hill. The Hill reports that the Senate will be holding Trump administration confirmation hearings this week. 

Health IT Security reports that 57% of surveyed consumers in a recent Black Book study are unwilling to use health care provider data portals, etc. due a fear of having their records hacked and a perceived lack of privacy. That's not good news.

"Incomplete medical histories and undisclosed conditions, treatment or medications raises obvious concerns on the reliability and usefulness of patient health data in application of risk based analytics, care plans, modeling, payment reforms, and population health programming," Black Book Managing Partner Doug Brown said in a statement. "This revelation should force cybersecurity solutions to the top of the technology priorities in 2017 to achieve tangible trust in big data dependability."

Drug Channels is back from a holiday vacation with a report on merger and acquisition activity in the specialty pharmacy sector. It's quite active.  Drug Channels "estimate[s] that total prescription dispensing revenues from specialty drugs at retail, mail, long-term care, and specialty pharmacies hit a record $115 billion." Woo hoo!

TGIF

Ah, the beginning of the first weekend of the NFL playoffs. Although my Redskins are not in the hunt, it still will be fun to watch so let's get to it.

Following up on Wednesday's post, the House did pass the REINS Act (HR 26). Reuters reports that the Democrats plan to fight the anti-administrative state bills in the Senate.

To the FEHBlog's surprise, he noticed that U.S. District Judge Berman proceeded with the second / regional competition phase of the trial over the government's effort to block the Anthem / Cigna merger. The FEHBlog expected a decision between the first / national competition phase and the second phase but that didn't happen. Indeed the second phase of the trial, according to Healthcare Finance, ended on Wednesday. So both of the anti-trust cases involving health insurer mergers, the Aetna/Humana merger and this one, are in the hands of their respective judges for a decision which should be annnounced this month.

All of the federal agencies this week issued exit reports to assist the incoming Trump administration. OPM's report can be found here.  The FEHBP is briefly discussed on the last page of the report.

Mid week update

The 115th Congress took the reins yesterday, and efforts to repeal the Affordable Care Act are underway.  The FEHBlog finds interesting the House of Representative's efforts to strengthen Congress's authority over the rulemaking authority of the regulatory agencies. This makes sense to the FEHBlog because the Constitution does give the legislative authority to Congress.  The House already has sent to the Senate a bill that would facilitate the Congressional override of Obama Administration regulations finalized over the past year (the Midnight Rules Act). The House also is actively considering a bill that would require Congressional and Presidential approval of major rules which by definition have an economic impact of $100 million or more on the national economy (the REINS Act). These laws supplement the in force Congressional Review Act.

By design of its enactors, the Affordable Care Act has been implemented through reams of regulations and sub-regulatory guidance, e.g., the 35 (or XXXV) sets of Frequently Asked Questions which typically tightened the screws on insurers. When the Trump Administration takes the reins at the agencies that administer the ACA -- the Health and Human Services Department, the Labor Department, and the Internal Revenue Service -- the new leadership can scale back the existing rules following processes set forth under the Administrative Procedure Act. Assuming for example that Congress does not override the onerous HHS PHSA Section 1557 rule, new leadership at HHS can revise that rule by, for example, narrowing its scope, reinstating exhaustion of administrative remedies, etc.  What's more, the new leadership can simply withdraw or rewrite the subregulatory guidance as desired.  Live by the simplicity of subregulatory guidance, etc. 

The FEHBlog does not plan to breathlessly track the course of the efforts to repeal and replace the ACA. He will discuss impact of the legislative process on the FEHBP as events warrant. 

The FEHBlog has discovered that Title VII of the FY 2017 National Defense Authorization Act includes a boatload of TRICARE changes. Section 712, for example, requires the Defense Secretary to report to Congress in June 2017 about the best way to offer coverage to military reservists and their families. One of the options is allowing those folks to enroll in the FEHBP. 

In the mid-1990s, the Defense Department encountered a problem in providing coverage to military retirees who are not eligible for Medicare. Congress created a pilot program in the FEHBP which provided for FEHBP carriers to set up separate plans for these retirees. The pilot program was an epic fail because the premiums were too darn high. At the turn of the century, Congress created an expensive TRICARE for Life program for these retirees.  Interestingly, Section 715 of the NDAA provides entry for these retirees into the Federal Employees Dental and Vision Insurance Program in 2018.  That's what should have be done at the turn of the century.  Adding Indian tribal employees to the FEHBP risk pools has worked out fine.  (Not every ACA change was wrongheaded). 

Section 712 of the NDAA also authorizes the Defense Secretary and the OPM Director to create a separate health insurance marketplace for the reservists modeled on the FEHBP. That idea strikes the FEHBlog as an opportunity to repeat the failure of the similar military retiree pilot program in the 1990s.  But no one on the Hill asked the FEHBlog. 

First post of 2017

 Happy New Year!  The 115th Congress goes to work tomorrow. This gives Congress a two and half week long head start on the executive branch before the clock starts to run on the Trump Administration's first 100 days.

On Saturday afternoon, at the 11th hour, a federal judge from the Northern District of Texas ruled  that the government "Defendants are hereby ENJOINED from enforcing the [HHS PHSA 1557] Rule’s prohibition against discrimination on the basis of gender identity or termination of pregnancy." A copy of the preliminary injunction decision is available here.  The FEHBlog was pleased for the plaintiffs but he erroneously thought that the lawsuit also encompassed other onerous provisions of the rule, such as the document translation requirements.

An injunction against provisions of the rule not found in the statute, such as the document translation requirements, would have nullified those requirements. The issue of whether PHSA Section 1557 reaches the two issues that the court addressed can be fought out in private litigation, even if the government cannot enforce the rule. So the decision is a half loaf, which of course is better than none.

Healthcare Dive had an useful report on the optimism and challenges for putting value in value-based care.

The FEHBlog also ran across two interesting studies:

• UPI reported on "A new [Journal of the American Medical Association] study of health care costs found that just 20 conditions make up more than half of all spending on health care in the United States. The study, which covered 155 conditions, showed the most expensive health condition was diabetes, which totaled $101 billion between diagnoses and treatment costs, and spending increased 36 times faster than the cost of heart disease." Heart disease was ranked number 2 in the study.  Back and neck pain ranked third.  "Aside from the top three conditions, hypertension and injuries from falls made up 18 percent of all personal health spending and totaled $437 billion in 2013. Other conditions among the top 20 included musculoskeletal disorders, such as tendinitis, carpal tunnel syndrome and rheumatoid arthritis."

• Physicians' Briefing reports that 

[JAMA Pediatrics] researchers observed an increase in health care spending on children from 1996 to 2013, from $149.6 billion to $233.5 billion. The largest health condition leading to health care spending for children was inpatient well-newborn care in 2013. The second and third largest conditions were attention-deficit/hyperactivity disorder and well-dental care. In 2013, infants younger than 1 year had the greatest spending per child at $11,741. There was an increase in health care spending per child from $1,915 in 1996 to $2,777 in 2013. In absolute terms, the greatest area of growth in spending was ambulatory care among all types of care; among all conditions, the greatest areas of growth were in inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma.

The FEHBlog presumes that it's no coincidence that the federal government's State Children's Health Insurance Program law was enacted in August 1997.  Not a knock on health care spending for children; just an observation.