Health Policy Reports

Biweekly newsletter of stories impacting community cancer care.
May 14, 2024

Health Policy Report – May 14, 2024

UnitedHealth Group CEO Appears Before Congress to Discuss Change Healthcare Cyberattack

On May 1, UnitedHealth Group (UHG) CEO Andrew Witty faced bipartisan criticism of his handling of the ransomware attack on Change Healthcare during his testimony before the Senate Finance Committee and the House Energy and Commerce Committee’s Oversight and Investigations Subcommittee.

During the Senate Finance Committee hearing, Chair Ron Wyden (D-OR), criticized Witty’s handling of the cyberattack, which led to major disruptions and compromised sensitive health information of providers, patients, and insurers. Witty acknowledged that a Change Healthcare server was accessed without multi-factor authentication and deployed ransomware after data exfiltration containing protected health information. Witty did note that while medical records appear uncompromised, the company is providing credit monitoring due to the scale of the breach.

Meanwhile, Senator Elizabeth Warren (D-MA) noted that UHG has bought up “every link in the health care chain,” owning “the country’s largest insurer, the country’s largest claims processor, the country’s third-largest pharmacy benefit manager.” Warren also asserted that UHG is leveraging financial fallout from the attack to buy up struggling medical practices. 

During Witty’s testimony in the House Energy and Commerce Oversight and Investigations subcommittee, he confirmed that the hackers were paid $22 million in ransom, leading House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) to suggest that UHG was “rewarding criminals” by handing over the ransom. The lawmakers’ remarks echo a growing skepticism of big healthcare deals on Capitol Hill, positioning Congress to take action on vertical integration in the healthcare system. 

To read more, CLICK HERE.

To watch the House Energy and Commerce Committee’s Oversight and Investigations Subcommittee hearing, CLICK HERE.

To watch the Senate Finance Committee hearing, CLICK HERE. 

Department of Justice Unveils Taskforce on Healthcare Monopolies
The US Department of Justice (DOJ) recently announced the formation of the Antitrust Division’s Task Force on Health Care Monopolies and Collusion (HCMC), which will guide the division’s enforcement strategy and policy approach in healthcare. The task force is intended to identify and eliminate monopolies, as well as any collusive practices that increase costs and decrease quality.

The HCMC will consider competition concerns, including payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, and access to and misuse of healthcare data. Under the leadership of Katrina Rouse, a long-serving antitrust prosecutor, the HCMC will facilitate advocacy, investigations, and, where warranted, civil and criminal enforcement in healthcare markets. “Every year, Americans spend trillions of dollars on health care, money that is increasingly being gobbled up by a small number of payers, providers and dominant intermediaries that have consolidated their way to power in communities across the country,” said Assistant Attorney General Jonathan Kanter of the Justice Department’s Antitrust Division.

The announcement comes as concerns grow about healthcare monopolies, which can be spurred by hospital consolidation, and its effect on consumers’ premiums and out-of-pocket spending. As a result, lawmakers have stepped up scrutiny of corporate interests and ownership in healthcare.

To read the announcement, CLICK HERE.

To read more, CLICK HERE.

House Ways & Means Committee Passes Telehealth Extension

On May 8, the House Ways & Means Committee advanced legislation to extend Medicare telehealth flexibilities through 2026 and relied on a package of pharmacy benefit manager (PBM) reforms and extensions of Medicare clinical laboratory and hospice pay cuts to cover the cost of the legislation.

The PBM reform offsets would delink PBMs’ income from anything outside of services, create more transparency through reporting requirements, and implement an annual audit of PBMs. The Congressional Budget Office expects the PBM provisions will save the federal government up to $700 million altogether. 

The bill also extends Medicare programs aimed at sustaining rural and low-volume hospitals through September 30, 2025. However, the legislative package drew criticism from both sides of the aisle, with lawmakers expressing concern that the bill does not extend the Medicare programs for as long as the telehealth policies. Additionally, lawmakers expressed concern that the PBM reforms would increase premiums for seniors. 

The legislative package, which ultimately passed the committee as an amendment in the nature of a substitute (AINS) by a vote of 41-0, will now wait to be taken up on the floor for a full House vote before the end of the year. 

To read more, CLICK HERE.

Senate Finance Committee Releases Drug Shortage Prevention and Mitigation Draft Legislation

In a bid to solve worsening drug shortages, the Senate Finance Committee has proposed legislation offering incentives to hospitals and other providers to stockpile certain medications. The draft bill, known as the Drug Shortage Prevention and Mitigation Act, would encourage providers to sign longer-term purchasing arrangements and spur manufacturing of drugs in short supply. 

“It is unacceptable that America is consistently running out of affordable and essential generic medicines,” said Senate Finance Committee Chair Ron Wyden (D-OR) in a press release. “Our bipartisan proposal uses the power of Medicare and Medicaid to ensure the entire American healthcare system has adequate supply for key medicines across the country.”

The program, which would begin in 2027, would allow group purchasing organizations (GPOs) and manufacturers to participate. The program would implement standards including minimum three-year contracts with manufacturers, purchase volume commitments, requirements for contingency contracts with alternate manufacturers and transparency around manufacturer quality control issues.

Hospitals and other providers who meet these standards would receive quarterly lump-sum Medicare payments for meeting basic and advanced standards, plus additional payments amounting to 5% to 25% of the price of specified drugs. The bill would also include exemptions to Medicaid rules requiring drug makers to pay rebates when their prices rise faster than inflation. 

This bill comes after Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) released a white paper in January outlining policy options regarding drug shortages.

To read a press release on the legislation, CLICK HERE.

To read the legislative text, CLICK HERE.

To read more, CLICK HERE.

USPSTF Releases New Breast Cancer Screening Guidelines

The US Preventive Services Task Force (USPSTF) recently revised its recommendation that women should begin receiving mammograms at age 40, but only every two years, a decision that has sparked debate in the cancer community. 

The change in the recommendation brings it more in line with current clinical practice and with guidelines from other leading societies, including the American College of Radiology (ACR) and Society of Breast Imaging, both of which recommend annual screening starting at age 40. 

While many see this as an improvement to the USPSTF’s previous guidance, which recommended biennial mammograms starting at age 50, it has raised concerns among groups like the American Cancer Society and Susan G. Komen, who recommend annual mammograms and additional screening for higher-risk patients, such as those with dense breasts. Specifically, the groups raised concern about potential out-of-pocket costs for higher-risk patients, as supplemental screening like MRIs or ultrasounds may not be covered by insurance. 

The USPSTF also weighed in on the question of continued screening for women ages 75 and older, and supplemental screening using breast ultrasonography or MRI in women with dense breasts on an otherwise negative screening mammogram but concluded that current evidence is insufficient to make recommendations in either case. 

To read the USPSTF’s recommendation, CLICK HERE.  

To read more, CLICK HERE.