Accessibility and affordability of care have been among the most-debated topics in health this season, with SmartBrief readers clicking on news stories about insurance marketplace premium hikes, medical billing reform, the cost and coverage of weight loss drugs and the availability of free COVID-19 tests as cases of infection see a resurgence in some areas.
Here’s a roundup of some of the most-read topics among SmartBrief subscribers in August.
ACA marketplace premium hike likely
What happened: Early in August, insurance companies participating in the Affordable Care Act marketplace proposed a median premium hike of 7% for 2025. That’s compared with the 6% increase established for the current year.
Insurers point to rising care prices – especially for hospital services – as the impetus behind a premium increase for next year. Rising use of specialty drugs such as weight-loss and diabetes medications figures into the mix, and a KFF analysis found that hospital consolidation and ongoing staff shortages also have an inflationary effect on premiums. (In the end, subsidies have tended to protect plan enrollees from most of the financial impact of a premium hike.)
What’s next: Recent news stories from states including Maine, Georgia, Pennsylvania and Washington outline what residents’ bottom-line costs are likely to be if pandemic-era subsidies are not renewed.
Surprise billing arbitration rules struck down
What happened: A federal appeals court affirmed a lower court’s decision that invalidated parts of the surprise billing arbitration process set forth by the CMS. The Fifth Circuit Court’s decision supported a February 2023 ruling from the Eastern District of Texas, which held that the arbitration methodology was biased toward payers. The Texas Medical Association challenged the methodology, saying it was not consistent with provisions of the No Surprises Act. A Biden administration appeal was not successful.
What’s next: The ruling could necessitate a pause in the CMS’ dispute resolution process as the agency reexamines its approach. The Texas Medical Association supported the decision, saying that federal agencies must adhere to the law.
Weight loss drugs may come with heavy cost
What happened: Research published in JAMA Health Forum showed that Medicare and Medicaid enrollees were much less likely than privately insured patients to get a prescription for the weight loss drug semaglutide. Less than 29% of 2023 Ozempic prescriptions went to Medicare Part D enrollees, as did about 1% of Wegovy prescriptions – and less than 10% of both drugs were prescribed to Medicaid enrollees. Researchers expressed concern that the lack of coverage could feed into health disparities for historically underrepresented and low-income groups. The drugs tend to cost $1,000 or more per month.
What’s next: Early trial results suggest that amycretin, a new weight loss medication in daily pill form, may offer an alternative to the injectable drugs. Ozempic and Wegovy maker Novo Nordisk is also the developer of the new drug.
Free COVID-19 test program returns
What happened: In late August, the White House announced the free COVID-19 test kit program would be reinstated this month. Once again, Americans can order four free tests through the covidtests.gov website and have them shipped to their homes. The announcement was made after updated vaccines from Moderna and Pfizer/BioNTech gained regulatory approval.
The CDC recommends that everyone ages 6 months and older get the updated vaccine, along with a current flu shot. CDC director Dr. Mandy Cohen noted that while a summer surge in SARS-CoV-2 cases doesn’t appear to be causing a spike in deaths or hospitalizations, it’s still important for people to protect their health with the latest vaccine and appropriate testing.
What’s next: Some states such as Minnesota, Washington and California have reported recent rises in SARS-CoV-2 infections. An Association of American Medical Colleges analysis breaks down recent hospitalization and mortality figures, as well as the virus’ mutation history.
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