Access & Coverage:

• A state court in Missouri said the government must begin allowing low-income residents to enroll in its Medicaid program, and may not impose stricter eligibility standards than on current enrollees. The order comes two weeks after the Missouri Supreme Court upheld the constitutionality of a 2020 ballot measure where voters approved expanding Medicaid in the state. (Article here)

D.C. News:

• The Senate voted to advance the $1.2 trillion bipartisan infrastructure package by a vote of 69-30. Then, early this morning, Senate Democrats approved their $3.5 trillion budget resolution in a 50-49 vote along party lines. Both bills now head to the House for approval. Only after both chambers pass the budget resolution will Democrats be able to use the reconciliation process to pass the legislation on a party-line vote. (Articles here, here, here, here, here, here, here, here, and here)
• Senate Democrats introduced legislation that proposes a series of comprehensive changes to nursing homes. The bill would require nursing homes to meet minimum staffing standards to avoid quality problems, hire full-time infection control and prevention specialist, and have a registered nurse available 24 hours a day. The bill would also provide temporary additional federal resources through Medicaid to increase wages and support the recruitment and retention of staff, as well as support improvements in resident care. (Articles here and here)

Inequities and SDOH:                                                            

• A report commissioned by the Better Medicare Alliance found significant growth among Medicare Advantage plans that offer benefits focused on social determinants of health. Since Special Supplemental Benefits for the Chronically Ill were available in 2020, the 245 plans that offered non-primary-care health benefits to members swelled to 845 in 2021. Health plans have focused on four primary areas: food insecurity, housing instability and homelessness, transportation access, and loneliness and social isolation. (Report here)

Life Sciences:

• A new preprint study found the Pfizer COVID-19 vaccine was only 42 percent effective against infection in July, when the Delta variant was dominant. It’s unclear whether the results signify a reduction in effectiveness over time, a reduced effectiveness against Delta, or a combination of both. In a statement, Pfizer said it and BioNTech “expect to be able to develop and produce a tailor-made vaccine against that variant in approximately 100 days after a decision to do so, subject to regulatory approval.” (Article here)

Payers:

• Aetna announced it is launching Aetna Virtual Primary Care – a solution backed by Teladoc Health’s physician-led care team model that harnesses Aetna’s provider network and the slate of services provided by CVS Health. Patients will have access to a continuous relationship with a virtual primary care doctor, which begins through a 30- to 45-minute initial visit and extends to subsequent visits. Members can also connect to a diverse array of physicians and specialists depending on their needs. (Press release here)
• Health Care Service Corp. (HCSC) announced it plans to expand its Medicare Advantage (MA) offerings to more than 90 counties that are home to 1.1 million Medicare-eligible residents. The Chicago-based not-for-profit insurer said the expansion is the largest in its history. HCSC has added 19,000 physicians and 2,800 hospitals and other facilities to its provider networks to meet new MA members’ expected demand for medical care. The insurer is also developing a marketing strategy to encourage Medicare beneficiaries in its new service areas to switch to MA during the next open enrollment period. (Press release here)

Providers:

• A class-action lawsuit filed against HCA’s health system in Western North Carolina argues that patients in the hospital system’s service area are charged higher rates and subsequently pay more in premiums than the rest of the state. The lawsuit alleges that HCA is able to use its monopoly power and anti-competitive negotiation tactics to obtain significantly higher prices. (Articles here and here)