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Washingtonian Recognition, Congress On The Family Glitch Fix, Telehealth In Medicare, And More

President at Paragon Health Institute
Brian Blase, Ph.D., is the President of Paragon Health Institute. Brian was Special Assistant to the President for Economic Policy at the White House’s National Economic Council (NEC) from 2017-2019, where he coordinated the development and execution of numerous health policies and advised the President, NEC director, and senior officials. After leaving the White House, Brian founded Blase Policy Strategies and serves as its CEO.

I was honored to be listed by the Washingtonian as one of the top 500 policy influencers in Washington. From the print version, here’s the blurb: 

“A former special assistant to President Obama, Blase wants Paragon, which launched last November, to grow into the premier health-policy think tank in the country, conducting both state and federal research and analysis.”

You probably noticed that they made a mistake. While I did work in the White House, it was for President Trump, not for President Obama. The error will be corrected in the online version (available May 4) but remains in the print version. Regardless, I am honored by the recognition.  

Bicameral Oversight Letter on Illegal Family Glitch Fix

On April 8, I published an op-ed in the Wall Street Journal criticizing the White House’s politicization of the IRS to illegally expand Affordable Care Act (ACA) subsidies. Additionally, the IRS proposed rule to fix the so-called family glitch is bad policy. It would significantly increase federal deficits and crowd out employer coverage with heavily subsidized exchange plans. I concluded my op-ed with a recommendation that “Congress has a duty to get to the bottom of the IRS proposed illegal rule and take steps to check the overt politicization of the tax code.” 
Citing my work, Ranking Member of the House Committee on Ways and Means Kevin Brady and Ranking Member of the Senate Committee on Finance Mike Crapo sent an oversight letter to Treasury Secretary Yellen on April 28. Kudos to members of Congress for taking steps to protect the rule of law and seek information about the White House’s political pressure on the IRS to take this unlawful action. From the congressional letter:

“The Biden Administration’s attempt to change statutory law without congressional action is both troubling and illegal. The Obama Administration’s Treasury Department reviewed all arguments regarding the proposed interpretation and found them lacking.”

The letter also cited numerous policy concerns—including that this proposed rule would, among other things, worsen inflation:

“…unilaterally redefining the application of the ACA’s insurance affordability standard could result in substantial disruption for workers and job creators alike, in addition to exacerbating 40-year-high inflation through tens of billions in new taxpayer spending. … We urge the Administration to pause this misguided approach and undertake a full review of the proposal, including the legal basis for this new interpretation of statute.”

A More Cautious Approach to Telehealth Expansion in Medicare
In my previous newsletter, I agreed with thoughts from former CBO Director Doug Holtz-Eakin who urged caution about the COVID-related telehealth expansions in Medicare, including the fiscal consequences if the expansions are made permanent without “fiscal guardrails.” While telehealth has the potential to improve patient access to care, its true value for improving health remains uncertain. It also has the potential to lead to significant waste, fraud, abuse, and misspending in Medicare given its fee-for-service nature, lack of utilization controls, and virtually nonexistent program integrity components. Both the Medicare Payment Advisory Commission and the Health and Human Services Office of the Inspector General are gathering information about the risks of expanded telehealth in Medicare. These risks should be fully understood before Congress acts to expand telehealth in Medicare, beyond the temporary measures. 
On April 21, the Committee for a Responsible Federal Budget (CRFB) released an important policy brief that provides more detail about these fiscal concerns. CRFB discussed likely problems with permanently expanded telehealth, such as up-coding time and complexity, misrepresenting provided services, and billing for services not rendered. From CRFB:

“Rather than make permanent decisions in the coming months, any extension of telehealth authorities should have proper guardrails, checkpoints to allow for data analysis and learning, and a way to align incentives for better and less expensive care. […] 
It is especially important that policymakers resist calls for mandating permanent payment parity, where telehealth visits are paid at the same rate as in-office visits. Doing so would drive up overall health care costs, undermine any potential telehealth might have to reduce costs in select circumstances, and be highly problematic for the goal of appropriately aligning incentives.”

This summer, Paragon will publish a policy paper on telehealth, which will examine the evidence to date. 
Government Failure on COVID
Finally, Dr. Joel Zinberg, the director of Paragon’s initiative on Public Health and American Well-Being—continues to be a leader on evaluating and critiquing the government’s response to the COVID pandemic. Joel’s recent NY Post piece highlighted studies pertaining to the various mistakes politicians have made regarding the pandemic—including lockdowns, mask mandates, and disregard for natural immunity. Joel concluded:

“The verdict is in: The experts were too cautious in ways that hurt schoolchildren, the economy and the general population without improving health outcomes. They imposed ineffective policies on everyone instead of protecting older Americans and those with comorbidities who represent the vast majority of COVID deaths.”

Joel also did a Federalist Society podcast last week explaining the recent court ruling striking down CDC’s travel mask mandate as well as the potential next steps of the Biden administration.      
As always, I appreciate the opportunity to share with you the impactful work Paragon is doing and my thoughts on some of the latest policy developments. 

All the best,
Brian Blase
Paragon Health Institute

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