As noted in the Quick STAT page of this issue of the newsletter, in calendar year 2020, the Medicare program had a total of 62.8 million enrollees. As described in an article published on April 27, 2021 in JAMA Network Open, overuse is defined as the delivery of tests and procedures that provide little or no clinical benefit, are unlikely to have an impact on clinician decisions, increase health care spending without improving health outcomes, or risk patient harm in excess of potential bene-fits.Estimates suggest that overuse contributes $75.7 billion to $101.2 billion to wasted U.S. health care spending annually. Results of a cross-sectional study involving 1,325,256 services performed at 3,351 hospitals show that measurements of low-value services using Medicare claims data can be applied to individual hospitals to compare their overall rates of overuse. The analysis revealed differences in overuse by hospital characteristics such as teaching status, region, and nonprofit status. Researchers found that hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse. Investigations of this nature are critical to developing remedies to curb unnecessary spending. A steady increase in the number of aged beneficiaries who become eligible to participate in the Medicare program means that a corresponding growth will occur in the amount of health services that must be provided for them. Constant efforts are needed to ensure that an ever growing amount of expenditures for such care is used effectively and appropriately. Biden Administration Begins Reversing Policies Established By The Previous AdministrationA common practice in recent years is for an incoming U.S. presidential administration to review health policies instituted by its predecessor administration and decide to reverse them. Along lines of efforts to prevent unnecessary spending in the Medicare program, the Biden administration decided to freeze an effort implemented by the Trump administration to create a new Medicare coverage and reimbursement pathway for “breakthrough” medical devices as its term drew to a close. A final rule known as the Medicare Coverage of Innovative Technology (MCIT) pathway that was published on January 14, 2021 in the Federal Register would have established a mechanism to provide national Medicare coverage for a period of four years after the date of U.S. Food & Drug Administration approval. The final ruling was to become effective on March 1 of this year. An argument opposed to implementing the rule is based on an assessment by the Biden team that the proposed acceleratedpathway fails to protect patients adequately or ensures that such breakthrough devices are effective or appropriate for the Medicare population Another illustration of an attempt to erase policies established by the preceding administration is that the Biden group will enforce legal protections against discrimination for gay and transgender patients seeking health care under the Affordable Care Act (ACA). During the Trump administration, a policy was implemented that aimed to define the scope of sex discrimination under the health law more narrowly than what was prescribed during the Obama Administration. The most recent ruling is based on a Supreme Court decision in 2020 that allows in a more expansive way the U.S. Department of Health & Human Services to interpret the antidiscrimination section of the ACA by forbidding bias “on the basis of race, color, national origin, sex, age or disability.” American Rescue Plan Act And The Affordable Care ActCongress passed the American Rescue Plan Act (ARPA) using what is known as the “budget reconcilia-tion process” that requires only a Senate majority rather than the sixty votes normally needed to over-come a filibuster. President Biden signed it into law on March 11, 2021. The aim of this legislation is to enable a temporary expansion of the ACA’s premium tax credits and to allow increases in federal financial incentives for states that have not yet done so to expand their Medicaid programs to low-income adults. A recent broadened enrollment period has resulted in an increase in the number of beneficiaries wanting to participate in this program. ARPA also provides incentives for the twelve states that have not yet expanded their Medicaid programs to all adults with incomes up to 138% of the federal poverty level.Meanwhile, the fate of the ACA will depend on a decision that soon will be made by the U.S. Supreme Court on a case that has attracted enormous interest in health policy circles.

HEALTH REFORM DEVELOPMENTS

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