No. of Recommendations: 1
They would simply argue that the PPACA does not specifically authorize HHS or CMSWhy are you arguing Obamacare's statute? Is that the only one governing healthcare?
At any rate, the point here is that people need to see what they're paying for healthcare. Full stop. We will never reduce health care costs until we get some semblance of a market going.
I get that the democrats want to protect the status quo and/or keep the graving train flowing for their interests, but this is another 80/20 issue they're going to find themselves on the wrong side of.
By statute - not Obamacare - CMS has the ability to enforce health care reforms with insurers. While the primary responsibility falls to the states to do that CMS does have the ability to partner with them to nudge the insurance companies. I expect they'll do that here with the willing participation of several states.
They also have authority derived from the No Surprises Act of 2022:
https://www.uofmhealth.org/no-surprises-act-nsa#:~....
Patients have the right to receive a “good faith estimate” explaining how much your healthcare will cost.
Healthcare providers are required to give patients an estimate of their bill for healthcare services before services are provided.So this is merely an extension of something they're already doing.
The Consolidated Appropriations act of 2021 mandates reporting out on pricing and pricing trends. Here's last year's report:
https://www.dol.gov/sites/dolgov/files/ebsa/laws-a...Executive Summary: Key Findings on Prescription Drug Spending, Pricing Trends,
and Contributions to Premium Changes
Prescription drug prices are a top concern for policymakers and the public. As detailed in a recent report
by ASPE, more than 4,200 drug products had manufacturer list price increases from January 2022 to
January 2023; the average change in the manufacturer list price of these drugs was 15.2 percent, and 46.0
percent of these drugs had price increases that were higher than the rate of general inflation.1 For many
drugs, however, list prices are not the prices ultimately paid to manufacturers; payers or pharmacy benefit
managers (PBMs) negotiate with manufacturers over formulary placement in exchange for discounts in
the form of rebatesa off the list price.
Furthermore, these post-rebate or net prices paid by private health insurance plans and issuers may be
higher than the net prices received by manufacturers given supply chain markups and amounts retained
by or paid to PBMs. However, comprehensive data on the net prices paid by private health insurance
plans, issuers, and consumers do not exist for private health insurance coverage. To address that gap in
data availability, section 204 of Division BB of Title II of the Consolidated Appropriations Act, 2021 (CAA)
(“Section 204”) directed group health plans and health insurance issuers offering group or individual (non
group) health insurance coverage (“private health insurance plans and issuers”) to submit annually certain
data on premiums, enrollment, nondrug medical spending, spending on prescription drugs, and
prescription drug rebates to HHS, the Department of Labor (DOL) and the Department of the Treasury
(UST) (collectively “the Departments”).b,2 So what does that Act do?
https://www.warnerpacific.com/getmedia/4a79fec8-6b...
1. What is required under the Consolidated
Appropriations Act, Title II, Section 204 Prescription
Drug and Health Care Spending Report?
› The Medical and Rx Reporting provision (Section
204) requires health plans and payers to report
information on plan medical costs and prescription
drug spending to the Secretaries of Health and
Human Services, Labor, and the Treasury, and the
Office of Personnel Management (OPM) on an
annual basis. This requirement applies to group
health plans (including ASO plans, expatriate plans,
and grandfathered plans) and health insurance
issuers offering group or individual health
insurance coverage, with the exception of church
plans that are not subject to the Revenue Code.
› On November 17, 2021, the departments released
an interim final rule (IFR) with request for
comments (IFC). – With the IFR, the Departments released reporting
instructions that provided greater technical detail
regarding each data element; the reporting
instructions were updated on June 30, 2022. – The Departments are requiring plan/issuer
submission of information based on the
“reference year,” defined as the “calendar year
immediately preceding the calendar year in which
the Section 204 data submissions are due.”
› On June 28, 2022, additional guidance and
clarification was added regarding several
key report elements, including:– Plan list dates, Spend Categories and
Total Spending.– New Additional Categorization – Medical
Benefit Known, Medical Benefit Estimated and
Requirement to provide Premium Split between
Member/Employer in the 2022 report.I suppose one could make a
Chevron style argument here, but again, good luck with that.
