Strategic Move Exempts Health Law From Broader U.S. Statute
By ROBERT PEAR, NYT
WASHINGTON — The Affordable Care Act is the biggest new health care program in decades, but the Obama administration has ruled that neither the federal insurance exchange nor the federal subsidies paid to insurance companies on behalf of low-income people are “federal health care programs.”
The surprise decision, disclosed last week, exempts subsidized health insurance from a law that bans rebates, kickbacks, bribes and certain other financial arrangements in federal health programs, stripping law enforcement of a powerful tool used to fight fraud in other health care programs, like Medicare.
The main purpose of the anti-kickback law, as described by federal courts in scores of Medicare cases, is to protect patients and taxpayers against the undue influence of money on medical decisions.
Kathleen Sebelius, the secretary of health and human services, disclosed her interpretation of the law in a letter to Representative Jim McDermott, Democrat of Washington, who had asked her views. She did not explain the legal rationale for her decision, which followed a spirited debate within the administration.
(More here.)
WASHINGTON — The Affordable Care Act is the biggest new health care program in decades, but the Obama administration has ruled that neither the federal insurance exchange nor the federal subsidies paid to insurance companies on behalf of low-income people are “federal health care programs.”
The surprise decision, disclosed last week, exempts subsidized health insurance from a law that bans rebates, kickbacks, bribes and certain other financial arrangements in federal health programs, stripping law enforcement of a powerful tool used to fight fraud in other health care programs, like Medicare.
The main purpose of the anti-kickback law, as described by federal courts in scores of Medicare cases, is to protect patients and taxpayers against the undue influence of money on medical decisions.
Kathleen Sebelius, the secretary of health and human services, disclosed her interpretation of the law in a letter to Representative Jim McDermott, Democrat of Washington, who had asked her views. She did not explain the legal rationale for her decision, which followed a spirited debate within the administration.
(More here.)
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1 Comments:
Drug pricing and patent life is a concern.
It may fall into the question of how “you” are affected.
If you have been diagnosed with multiple sclerosis or rheumatoid arthritis, you will be pleased with this ruling. For example, AbbVie's (spun off from Abbot Labs) Humira, which also is used for rheumatoid arthritis and other conditions, can cost more than $2,500 for a month's supply. If you purchase your insurance before getting treatment, you might opt for a "silver" health plan offered through the exchanges which has a $2,500 deductible or a "bronze" plan's deductible is $5,000.
That means that a patient with, say, a 10% co-payment requirement would pay more than $250 out of pocket. The Humira co-payment-assistance program can lower that to $5 a month for eligible patients.
If on the other hand, you take generic drugs, you may be suspicious.
This is an interesting competition … on one side you have the Pharmaceutical Care Management Association, a pharmacy-benefit industry group being disappointed versus the Pharmaceutical Research and Manufacturers of America who are happy with the interpretation.
One thing that we have to remember is that pharmaceutical companies are contributing $85 billion to $90 billion in fees, drug-price discounts and other givebacks under the law. In return, they have been counting on drug spending to increase $120 billion from next year through 2022 as a result of millions more Americans receiving insurance.
We hear a lot of complaining from Klobuchar/Franken/Paulsen/Walz about the need to refund and repeal the Medical Device Excise Tax (which is about 1.5% after taxes and some companies are passing along the tax to the consumer just as is done with other excise taxes), yet we don’t hear the pharmaceutical industry demanding a roll-back … but if Klobuchar/Franken/Paulsen/Walz have their way, they will.
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