CENTER UPDATE | April 2023

In this Issue:

  • NPR’s On Point Highlights Court Ruling Striking Down ACA’s Preventive Service Provisions
  • Justice Department Seeks Stay on Parts of ACA Preventive Services Ruling
  • ACA Frequently Asked Questions Addresses Braidwood Ruling 
  • Insurers Say Free Preventive Care Will Continue While Lawsuit is Appealed
  • CMMI Publishes Medicare Advantage V-BID Model Fact Sheet
  • Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act
  • Seven Low-Value Services Are Responsible for Two-Thirds of Wasteful Spending
  • Key Preventive Screenings Low Across Washington
  • IVI No Value Without Equity Report
  • SHCC 2023 Annual Policy Summit
  • AHCJ Braidwood v. Becerra Webinar

NPR’s On Point Highlights Court Ruling Striking Down ACA’s Preventive Service Provisions

A new episode of NPR’s On Point covered last month’s Braidwood v. Becerra ruling that struck down the Affordable Care Act’s preventive services provision. University of Michigan’s Nicholas Bagley, Anand Parekh, and V-BID Center Director Mark Fendrick discussed the history behind this popular policy and the legal and clinical implications of the court decision. Read more here.

Justice Department Seeks Stay on Parts of ACA Preventive Services Ruling

On April 12, the U.S. Department of Justice filed a request for a partial stay of Judge Reed O’Connor’s judgement in the Braidwood v. Becerra case while its appeal works its way through the courts. The DOJ states that the stay would not impact the plaintiffs, 5 of which don’t purchase or provide insurance.

ACA Frequently Asked Questions Addresses Braidwood Ruling

The tri-departments (Department of Labor, HHS, and Treasury) and Office of Personnel Management have jointly released a 9-section FAQ sheet on the implementation of the Affordable Care Act and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The publication answers stakeholder questions stemming from the recent Braidwood v. Becerra decision to help people understand the law and promote compliance.

Insurers Say Free Preventive Care Will Continue While Lawsuit is Appealed

In response to a request for information, a joint letter to Democratic lawmakers notes that most health insurers do not plan to stop coverage of preventive care services. This follows Judge Reed O’Connor’s ruling in Braidwood v. Becerra late last month.

CMMI Publishes Medicare Advantage V-BID Model Fact Sheet

The Centers for Medicare and Medicaid Services recently published a fact sheet for Medicare Advantage organizations seeking to apply for the CY2024 MA V-BID model test, which will provide Medicare Advantage organizations opportunities to “better and more equitably serve patients, while helping them achieve improved health outcomes.” Beginning in 2025, MA V-BID model plans will offer supplemental benefits that address social determinants of health.

Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act

A recent KFF brief provides an overview of changes to Medicare Part D benefit design and enrollee cost-sharing requirements in response to the Inflation Reduction Act. This year, a $35 monthly cap on insulin costs and zero cost-sharing for adult vaccines were implemented. Here are key changes in 2024 and 2025:

  • 2024: The 5% coinsurance requirement for Part D enrollees in the catastrophic phase will be eliminated.
  • 2024: Part D plans will be required to pay 20% of total drug costs, up from 15% in prior years.
  • 2024: Medicare beneficiaries with incomes up to 150% of the limits for partial low-income subsidy benefits will be eligible for full benefits.
  • 2025: Out-of-pocket drug spending will be capped at $2,000.
  • 2025: Part D enrollees will have the option of spreading out their out-of-pocket costs over the year rather than face high out-of-pocket costs in any given month.

Seven Low-Value Services Are Responsible for More Than Two-Thirds of Wasteful Spending

An analysis of the Health Care Cost Institute’s dataset of employer-sponsored insurance claims has found that just 7 of 48 services determined to be low-value account for nearly 70% of all low-value service use and spending. These are cardiac screens for asymptomatic patients, Vitamin D deficiency testing among low and average risk patients, prostate-specific antigen screening, general health checks for asymptomatic patients, preoperative baseline laboratory testing, preoperative cardiac screenings, and inappropriate opioid prescriptions for non-cancer chronic pain.

Key Preventive Screenings Low Across Washington

The Washington Health Alliance reports that roughly 40% of commercially-insured individuals are not receiving colorectal cancer screenings in the state of Washington, with rates worsening amongst Medicaid-insured individuals. Additionally, 60% of commercially-insured women age 16 to 24 are not getting chlamydia screenings.

No Value Without Equity: Transforming Practice and Accountability for Equity in Health Technology Assessment

A new report from IVI synthesizes cross-stakeholder insights on barriers to health equity and provides a blueprint for achieving equity in health technology assessment. The report includes action steps that HTA assessors and researchers, life sciences companies, payers/purchasers, policymakers, publishers and professional societies, patient communities, and research funders can take in four key domains: power, people, and processes; data, inputs, and infrastructure; methods; and communications and use.

SHCC 2023 Annual Policy Summit

Register now for SHCC’s 2023 virtual policy summit on Tuesday, May 2, featuring keynote remarks from distinguished speakers Senator John Thune and Congressman Brad Wenstrup. The public forum will lay out a bipartisan policy roadmap for V-BID in the coming years, including improving access to chronic disease prevention and reducing low-value care.

Webinar: Covering the Lawsuit That Could Limit Free Preventive Care

On Wednesday, May 10, the Association of Health Care Journalists will be hosting a free webinar on the implications of the Braidwood v. Becerra ruling. Speakers will discuss how the ruling could limit or restrict the government’s ability to require health insurers and employers to cover evidence-based preventive services without cost-sharing.

A recording of the 2023 V-BID Summit is now available. Click on the button below to hear discussions around accelerating health equity, implications of overturning the ACA preventive care mandate, opportunities and challenges of reducing low-value care, and advances in policies to enhance affordability and reduce medical debt.

Watch the Recording

Please Help Support the V-BID Center

 

As we near the end of 2022, we recognize our accomplishments over the past year and look ahead to all we can achieve at the University of Michigan Center for Value-Based Insurance Design. Generosity from collaborators and friends like you allows us to remain focused on equity enhancing programs that improve access and affordability to essential clinical services

You will play an essential role in the future success of the V-BID Center by making a gift today. Thank you for your support.