The Health Wonk Shop

The Supreme Court’s June 28 decision overturning the Chevron precedent that required federal courts to defer to reasonable agency decisions when federal law is unclear creates potential challenges for crafting health policy legislation and regulations. On July 25, 2024, a panel of experienced policy and legal experts explored how Congress and federal health agencies are likely to adapt to the Court’s decision and what that may mean for health care policymaking.Moderated by Larry Levitt, KFF’s executive vice president for health policy, the discussion addressed questions including: How will the decision change how regulators approach drafting new regulations? What type of health policy regulations are likely to be most vulnerable to future court challenges? How will it alter the legislative process and the ability to pass new laws? To what extent will Congress be able to provide greater specificity in delegating authority to federal agencies in future legislation?

With Congress looking for ways to cut health care costs for patients and the Medicare program, one approach drawing bipartisan attention involves site-neutral payments for outpatient services. The idea is for Medicare to pay the same amount for a service regardless of where it is provided – a departure from current Medicare reimbursement policy, which generally pays higher rates for services provided in hospital outpatient departments versus independent physician offices and ambulatory surgical centers.Listen to a panel of experts discuss the concept of site-neutral payments, including why it has become an issue for policymakers and private payers like insurers and employers, how Medicare payments currently work, how various proposals would change the law, and the potential impact of those changes.

Nearly 1 in 5 consumers with health insurance say their insurer delayed or denied care in the past year due to its requirements for prior authorization, a process through which insurers can require patients to obtain approval in advance before they will agree to cover specific services.Insurers point to prior authorization as a tool to limit unnecessary and ineffective care, thereby reducing costs. However, the practice is also drawing increased scrutiny amid concerns that it creates unreasonable barriers to patients getting needed care and generates excessive paperwork burdens on doctors and other providers. Last month, federal regulators finalized new rules to govern how insurers use prior authorization in Medicare Advantage, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act’s federal Marketplace plans, while lawmakers are weighing potential broader legislation.On February 22, a panel of four experts joined Larry Levitt, KFF’s executive vice president for health policy, for a 45-minute discussion addressing the future of prior authorization requirements in health care. The panel discussed why insurers use prior authorization, its impact on patients and providers, and how the new regulations may change current practices. They also examined the potential for further regulatory or legislative actions to address ongoing concerns.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsTroyen Brennan, MD, Adjunct Professor of Health Policy and Management, Harvard T.H. Chan School of Public Health, and a former executive at CVS Caremark and AetnaFumiko Chino, MD, Radiation Oncologist, Memorial Sloan Kettering Cancer CenterAnna Schwamlein Howard, Principal, Policy Development, American Cancer Society Cancer Action NetworkKaye Pestaina, Vice President and Director of the Program on Patient and Consumer Protection, KFF

Amid low unemployment and rising demand for services, today’s health care workforce is under pressure from several directions, including worker strikes; shortages of trained staff; and proposed new staffing standards for nurses and aides in nursing facilities.On November 16, a panel of three experts joined Larry Levitt, executive vice president for health policy at KFF, for a 45-minute discussion focused on the diverse challenges facing the health care workforce. The conversation touched on why and where there are worker shortages, what is driving recent strikes, how these pressures affect health systems, and how the proposed new staffing requirements could affect nursing homes. The panel also explored differences in rural and urban settings, and how the pandemic and other factors have increased burnout among health care workers.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsGretchen Berlin, Senior Partner, McKinsey & CompanyAlice Burns, Associate Director of the Program on Medicaid and the Uninsured, KFFBianca K. Frogner, Director of the University of Washington’s Center for Health Workforce Studies, and Professor in UW’s Department of Family MedicineKFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights.

With the Biden administration’s announcement of the first 10 drugs to be negotiated for Medicare as part of the Inflation Reduction Act (IRA), an array of legal challenges from the pharmaceutical industry is potentially the biggest obstacle to implementation.In court filings, individual drugmakers and the industry’s main lobbying group contend that the negotiations process is unconstitutional in a variety of ways, from violating freedom of speech to unlawful government seizure and excessive fines. They also continue to argue, as they did in the debate over the IRA, that requiring companies to negotiate the prices of drugs with the government will impede the development of new drugs.On Tuesday, September 12, two legal experts and a health policy expert joined Larry Levitt, executive vice president for health policy at KFF, for a 45-minute discussion about the legal issues underpinning these lawsuits and how they intersect with the policy goals of the legislation. ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsZachary Baron, Associate Director, Health Policy and the Law Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University.Tricia Neuman, Senior Vice President and Executive Director of the Program on Medicare Policy, KFFDan Troy, Managing Director, Berkeley Research Group KFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights.

New weight loss drugs, such as Novo Nordisk’s Ozempic and Wegovy (semaglutide) and Eli Lilly’s Mounjaro (tirzepatide), could be transformative for people who struggle with obesity and obesity-related medical conditions, but there are major questions to consider related to insurance coverage, the cost of the drugs, and who has access.Importantly, by law, the drugs cannot be covered by Medicare for weight loss and are often covered now by private insurers in limited circumstances. Manufacturers of the drugs are lobbying for broad coverage by Medicare and other payers.On August 4, three experts joined Larry Levitt, executive vice president for health policy at KFF, for a 45-minute “Health Wonk Shop” discussion about the questions surrounding what a new generation of weight loss drugs means for patients and payers:Who could benefit most from the new weight loss drugs, and what are the barriers to accessing them?What would be the impact of Congress overturning the prohibition on Medicare covering weight loss drugs?How are employers and insurers approaching coverage of the drugs given the potentially substantial costs involved?What are the broader implications of the new drugs for U.S. obesity rates and for national health spending, including on obesity-related health conditions?ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsJuliette Cubanski, PhD, Deputy Director, Program on Medicare Policy at KFFShauna Levy, MD, MS, Assistant Professor, Division of MIS/Bariatric Surgery, Tulane University School of MedicineMichael Manolakis, PharmD, PhD, Senior Vice President, Pharmacy, Aon KFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights.

Pharmacy benefit managers (PBMs) are increasingly scrutinized intermediaries in the U.S. health care system, negotiating discounts on prescription medications for health insurers and employers while collecting rebates from drugmakers.Even as PBMs have taken on a larger role in drug coverage and pricing in recent decades, including through mergers with insurers, the business arrangements that shape their finances remain unusually opaque. That has led to questions about the role PBMs play in the rising cost of prescription drugs, investigations by Congress and the Federal Trade Commission into PBMs business practices, and federal and state efforts to regulate those practices and require greater transparency.On June 14, two experts joined KFF’s The Health Wonk Shop and series moderator Larry Levitt in a 45-minute discussion about the power and practices of PBMs, addressing such questions as:How do PBMs make money?What role do PBMs have in drug costs?What legislation or other reforms are being considered, and how would they affect consumers? ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsJennifer Reck, Director, Center on Drug Pricing, National Academy for State Health PolicyKaren Van Nuys, Executive Director of the Value of Life Sciences Innovation Program and Senior Fellow, University of Southern California Schaeffer Center for Health Policy and Economics KFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights.

The idea of imposing work requirements in Medicaid is making a comeback in Congress and at the state level.Some House Republicans are pushing to include such a measure in any deal to raise the debt ceiling. The policy resonates with a larger message of personal responsibility, and advocates suggest that work requirements could help achieve budget savings and create a pathway to prosperity for low-income people. Opponents argue that imposing requirements will not significantly increase work since most Medicaid enrollees already work, and would just create an additional administrative barrier to maintaining Medicaid coverage.On the state level, Georgia is poised to implement work requirements in a limited expansion of Medicaid this summer after a court overturned the Biden administration’s attempt to block the move administratively. In Arkansas, the only state to have implemented work and reporting requirements, thousands of people were disenrolled for failure to comply, including some who were eligible but could not navigate the process.On Tuesday, April 25 , three experts joined series moderator Larry Levitt in a 45-minute discussion about work and reporting requirements in public programs such as Medicaid, their effects on enrollment and employment, and what we can expect on the state and federal levels regarding the future of Medicaid work requirements.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsMadeline Guth, Senior Policy Analyst, Program on Medicaid & Uninsured, KFFHeather Hahn, Associate Vice President, Center on Labor, Human Services, and Population, Urban InstituteAngela Rachidi, Senior Fellow and Rowe Scholar, American Enterprise InstituteKFF’s virtual series, The Health Wonk Shop, features conversations with experts, diving into timely health policy issues for a deeper discussion beyond the news headlines.