The long and short of health plans

Jul 07, 2023

With Carmen Paun

Driving the day

Joe Biden walks.

President Joe Biden is expected to deliver a speech on short-term health care plans today. | Drew Angerer/Getty Images

BIDEN ON 2018 RULE — President Joe Biden wants short-term health care plans to last only three months instead of three years, POLITICO’s Robert King reports.

HHS, the Treasury Department and the Department of Labor will release several proposed rules Friday overturning a regulation from 2018 governing the plans. These short-term plans offer skimpy and limited — but cheaper — coverage meant to act as a stopgap between long-term insurance. Biden fulfills a request from Democratic lawmakers and patient advocacy groups who wanted him to act on the plans for years.

“Short-term plans are intended to provide temporary coverage as people transition from one source of coverage to another,” said Neera Tanden, White House domestic policy adviser, on a call with reporters Thursday. “Under the previous administration, however, companies were able to take advantage of loopholes and sell junk insurance for much longer than intended.”

Short-term plans currently run for three months but can be renewed for up to three years. In 2016, an Obama-era rule required the plans to be renewed for up to only three months.

Now, as first reported by POLITICO, Biden is expected to announce today that the plans can run for only three months and be renewed for only one additional month.

Consumers already enrolled in short-term plans will be grandfathered in, according to a senior administration official granted anonymity to discuss the plan details.

The plans must also clearly disclose the limits and provide consumers with a disclaimer on those limits.

The administration also released new guidance to clamp down on a surprise-billing loophole — one in which health insurers contract with a hospital but don’t identify them as “in-network.” This could lead to higher payments for consumers, according to a guidance fact sheet.

The guidance clarifies that hospitals must disclose “facility fees” that a consumer could be charged if they get care outside a facility, such as in a doctor’s office.

“These fees are often a surprise for consumers,” the fact sheet said.

The administration also wants feedback on how to crack down on high-interest medical credit cards that officials say can be peddled to older adults in doctors’ waiting rooms.

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At the Agencies

Vials and packaging for Eisai's Alzheimer's medication Leqembi.

The FDA approved the Alzheimer's drug Leqembi, but it won't be widely covered by Medicare. | Eisai via AP

LEQEMBI APPROVED — The FDA granted full approval to an Alzheimer’s drug for the first time in 20 years, POLITICO’s Katherine Ellen Foley reports.

But the drug won’t be accessible to every patient with Alzheimer’s. Medicare has said it will reimburse the drug’s costs — more than $26,000 annually — only for beneficiaries enrolled in a nationwide registry that tracks patient side effects and outcomes over time.

In trials, Leqembi, developed and manufactured by Eisai and Biogen, slowed participants’ cognitive decline compared to a placebo, according to the data. But the drug had potentially serious adverse effects, including brain swelling and bleeding.

Patient advocacy groups, lawmakers and some clinicians fear this means that few of the hundreds of thousands of patients with Alzheimer’s eligible for the treatment will be able to access it.

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Global Health

INTERNATIONAL HELP ON FENTANYL — Secretary of State Antony Blinken is holding a meeting this morning to officially launch a Global Coalition to Address Synthetic Drug Threats with more than 80 countries and several international organizations, Carmen reports.

The coalition brings together officials from countries such as Canada, Mexico and those in the European Union and Middle East to exchange knowledge about how to respond to the rise of synthetic opioids driving addiction, said a State Department official granted anonymity by POLITICO because the person wasn’t authorized to speak on the record.

This coalition is part of the U.S. effort to bring the world together in the fight against synthetic opioids such as illicit fentanyl, which is the country’s top killer of young adults.

Other participating countries struggle with drugs such as methamphetamine in Europe and the synthetic amphetamine-type stimulant Captagon in the Middle East, and there’s value in sharing experiences, the official told Carmen.

Participating countries, the official said, will work on three priorities until March 2024 when the U.S. and partner countries would decide whether to continue the coalition or make changes:

— Preventing the manufacturing and trafficking of illicit synthetic drugs

— Detecting emerging drug threats through data-sharing and forecasting to try “to identify the new fentanyl or the next meth before it gets here”

— Promoting appropriate health responses, including certifying health care workers and reducing stigma

Public Health

HIGH DRUG-TRAFFICKING AREAS INCREASE — The White House added nine counties to its list of high-intensity drug trafficking areas, which receive support to fight local drug production and trafficking, Carmen reports.

Two counties in Florida and one each in Kentucky, West Virginia, North Carolina, Pennsylvania, New York, Ohio and Oklahoma joined the 33 counties already on the list.

Created by Congress through the Anti-Drug Abuse Act of 1988, the High Intensity Drug Trafficking Areas program supports federal, state, local and tribal law enforcement agencies in areas deemed as critical drug-trafficking regions in the country. The areas are in the 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands.

Why it matters: “These new HIDTA designations will ensure our nation’s hardest-hit areas get the critical resources and support they need to crack down on illicit drug supply, prevent overdoses, save lives and make our communities safer,” said Rahul Gupta, the director of the White House Office of National Drug Control Policy.

IN THE STATES

ADA INVESTIGATION — The Justice Department announced Thursday it found “reasonable cause to believe” that South Carolina broke the law by needlessly institutionalizing people with mental illness.

The DOJ argued that the state didn’t offer adequate community-based services to prevent segregating people with disabilities by sending them to institutions — violating the Americans with Disabilities Act.

Instead, South Carolina subsidizes stays in adult-care homes, the DOJ said, which allows little contact with people who don’t have disabilities, effectively segregating them.

The South Carolina Department of Mental Health did not respond to a request for comment on the investigation.

What We're Reading

The Wall Street Journal reports on the impacts of the growing awareness of adult ADHD.

KFF Health News reports on the disparities that may be aggravated by the rollout of the newly FDA-approved Alzheimer’s drug.

The Washington Post reports on the gene-editing tools that helped crack a cancer mystery.

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