Welcome to Overnight Health Care, sponsored by the Pharmaceutical Care Management Association. It's Monday in Washington, where everyone is debating whether the president can actually pardon himself. But there's plenty of health care news on the agenda as well. ADVERTISEMENT The big story, though, takes us to Maine, where a state court is ordering officials to begin implementing Medicaid expansion. The details: A Maine court has ordered the state to move ahead with Medicaid expansion, which was approved by voters last year but blocked by Republican Gov. Paul LePage. The judge asked the state to produce a plan by June 11 on how it will expand the program. Backstory: Maine was the first state to expand Medicaid through a referendum. But LePage has fought those efforts at every turn, arguing that it would be too expensive. Critics, though, question his estimate. We'll have more on the late-breaking story here. *** ADVERTISEMENT Sponsored content - Pharmaceutical Care Management Association Pharmacy benefit managers (PBMs) are hired by employers, unions, and government programs to negotiate aggressive discounts from drug companies and drugstores. Learn how PBMs are part of the solution to reducing Rx costs at DrugBenefitSolutions.com. *** Also today, New York ObamaCare insurers are asking state regulators to approve an average rate hike of 24 percent. Meanwhile, 11 insurers in Washington state want to increase premiums by an average of 19.08 percent. Why it matters: Insurers in both states blame recent and upcoming changes to the law. In New York, insurers are concerned about Congress' repeal of the individual mandate, which takes place next year, and in Washington, insurers are concerned that looking action from the Trump administration could draw healthy people from the markets. Context: We're likely to see this trend continue for weeks or months to come as insurers finalize their rate requests. But remember, rates still need to be approved by state regulators. And those who receive subsidies to buy insurance will mostly be shielded from any increases. It's those who make too much to qualify for subsidies who will be most affected. We explain here. Inspector general finds surge in Medicare drug spending Advocates for lower drug prices got some new fodder on Monday with an HHS inspector general report finding a surge in drug spending despite a drop in the number of prescriptions. Key findings: ADVERTISEMENT Medicare Part D spending for brand-name drugs rose by 62 percent from 2011 to 2015, from $49 billion to $80 billion. That occurred even though the number of prescriptions fell 17 percent in the same time period. Unit costs for drugs rose 29 percent from 2011 to 2015, six times faster than inflation. Medicare enrollees' average out of pocket costs per brand name drug rose from $161 to $225 in that time period, an increase of 40 percent. Key quote: "Today's report from the HHS Inspector General makes it clear that list price increases on brand drugs are hurting patients," said David Mitchell, founder of the advocacy group Patients for Affordable Drugs. "I heard this weekend from a California woman who reports she pays $500 -- nearly half of her $1,200 per month income -- to cover two maintenance drugs. We need action to lower pharma list prices now." Read more here. ADVERTISEMENT A federal judge over the weekend ruled against the Trump administration in a class action lawsuit filed by dozens of organizations working to prevent teen pregnancy. The Department of Health and Human Services last year told participants in the Teen Pregnancy Prevention Program that their five year grants would be ending two years early, calling the program ineffective. This move prompted lawsuits, including the class action suit filed by 62 grant recipients. Judge Kentanji Brown Jackson of the U.S. District Court for the District of Columbia ruled over the weekend that the terminations were unlawful and HHS should proceed "as if the agency had not undertaken to shorten these grantees' federal awards." What it means: HHS will have to accept and process applications from grantees for their final two years of funding. It appears that grantees will be able to follow funding requirements set by the Obama administration, not new criteria issued under Trump that is focused more on abstinence. What to watch for next: Supporters of the program are waiting with baited breath, though, for HHS to decide its next steps, which could include an appeal. What HHS is saying now: From an agency spokesperson: ADVERTISEMENT "We are disappointed with this ruling," HHS spokesperson Caitlin Oakley said in a statement. "Continuing the program in its current state does a disservice to the youth it serves and to the taxpayers who fund it. Communities deserve better, and we are considering our next steps." *** Sponsored content - Pharmaceutical Care Management Association The Congressional Budget Office's $43 billion score of point-of-sale rebates in Medicare Part D is the latest in a series of official estimates showing this mandate would increase costs for the government and taxpayers. This score strikes the third blow to the drugmakers' multi-million dollar campaign to shift blame for their own prices onto the health plans and pharmacy benefit managers (PBMs) that negotiate discounts and rebates to reduce costs. *** CMS rolls out Medicaid scorecard CMS Administrator Seema Verma on Monday unveiled a new "scorecard" that provides data on different aspects of state Medicaid programs. The goal is to hold the program accountable, so "every American [can] see how well the Medicaid program is doing," Verma told reporters Monday. The National Association of Medicaid Directors, though, said they had concerns about the "comparability, accuracy and timeliness of the data." Another tidbit from Verma's briefing: She declined to comment on what President Trump Donald TrumpTrump lashes out after grand jury seated for New York criminal probe Schumer tees up vote on Jan. 6 commission bill Senators struggle to save Jan. 6 commission MORE meant when he said drug companies would soon be announcing voluntary price decreases. She said she did not want to get in front of any announcements. From the weekend: Blue states are defying the Trump administration in a bid to protect ObamaCare.<doc-sep>A Maine court has ordered the state to move ahead with Medicaid expansion, which was approved by voters last year but blocked by Republican Gov. Paul LePage. Michaela Murphy, a Maine Superior Court justice, ruled Monday afternoon that the state must submit a plan to the federal government by June 11 detailing how it plans to expand Medicaid. ADVERTISEMENT Maine voters approved expansion in November through a citizen-led ballot measure, but LePage has fought back at every turn. He said he wouldn't implement expansion unless state legislators found a way to pay for it without raising taxes. But expansion supporters argued the governor's estimate was too high. His administration missed the April 3 deadline to send a plan to the federal government, prompting lawsuits from the Maine Equal Justice Partners and Consumers for Affordable Health Care. Maine became the first state to expand Medicaid through a voter referendum. Medicaid expansion would make eligible an additional 70,000 Maine residents with incomes between 101 percent and 138 percent of the federal poverty level.<doc-sep>A judge has ordered the LePage administration to start the process of expanding Medicaid to 70,000 Mainers.Judge Michaela Murphy ordered the Maine Department of Health and Human Services to submit a plan to the federal government to start the process of expanding the government-funded health care program.DHHS has until June 11 to submit the plan to the Centers for Medicare and Medicaid Services.Maine voters approved expanding Medicaid in a statewide referendum last year.The LePage administration had argued that it could not expand Medicaid until the Legislature appropriates money for the expansion.Supporters have said that the money is there for Maine to expand the program. A judge has ordered the LePage administration to start the process of expanding Medicaid to 70,000 Mainers. Judge Michaela Murphy ordered the Maine Department of Health and Human Services to submit a plan to the federal government to start the process of expanding the government-funded health care program. Advertisement DHHS has until June 11 to submit the plan to the Centers for Medicare and Medicaid Services. Maine voters approved expanding Medicaid in a statewide referendum last year. The LePage administration had argued that it could not expand Medicaid until the Legislature appropriates money for the expansion. Supporters have said that the money is there for Maine to expand the program.<doc-sep>At a hearing late last month, a Maine judge said that Medicaid expansion was the law, “not a suggestion.” This week, the same judge ordered the LePage administration to file a plan within a week for extending public health insurance to thousands of Mainers. We hope the administration will comply with the court order, but given Gov. Paul LePage’s long-standing opposition to Medicaid expansion — he vetoed it five times — we don’t necessarily expect that to happen. The administration has not publicly commented on the ruling. Lawmakers can remove one of LePage’s excuses for not beginning the expansion process by appropriating the funds to do so. At least one legislative leader, Assistant Senate Majority Leader Amy Volk supports this course. “I think this is a good thing,” Volk, R-Scarborough, said on Twitter of the court ruling. “Conservative states across the country have models we can learn from. It’s time to implement what voters approved.” Voters last year approved an expansion of Medicaid, largely to be paid for by the federal government, to extend health insurance to about 70,000 low-income Mainers. That set in place a timetable of state actions that the administration has ignored. The Maine Department of Health and Human Services was required to file a plan for implementation of the expansion by April 3. The LePage administration has not filed the plan. Health care and anti-poverty advocates filed suit in late April to compel DHHS to file the required plan. At a hearing in late May, Superior Court Justice Michaela Murphy made it clear that complying with the expansion law was not optional. “The law is in effect. It’s not a suggestion,” Murphy said. “The executive branch has a duty to enforce that.” Murphy reiterated that point in a 13-page ruling on Monday and blasted DHHS for taking no action to comply with the requirements of the expansion law. “The [DHHS] Commissioner has not cited to any authority suggesting that an agency can be considered to have substantially complied with a directory statute by taking no action at all,” she wrote. “The Court concludes that the Commissioner’s complete failure to act cannot be considered substantial compliance” with the legal requirements. Murphy ordered DHHS to file the implementation plan by June 11. The judge also took a dim view of one of LePage’s chief excuses for not acting on Medicaid expansion — that the state cannot afford it. As a secondary argument, LePage has said his administration can’t act until the Legislature appropriates funds to pay for the expansion. While steering away from saying whether the Legislature needed to appropriate such funds, Murphy said that the administration needed to file the implementation plan regardless of whether the funds to cover the expansion were currently available. Advocates argue that the initial work can be funded with surplus funds within DHHS. The administration argues that new funding must be appropriated by lawmakers. “The Court is not persuaded that the executive branch is excused from clear statutory obligations by the legislature’s failure to follow through with legislative obligations,” Murphy wrote. This is a clear reminder to lawmakers that appropriating funds to cover the initial expansion work must remain a priority if and when they return to the State House. The Legislature adjourned in early May without completing its work, leaving many issues, including Medicaid expansion, in limbo. Legislative leaders are continuing to negotiate in hopes of returning to Augusta soon to address these issues. Lawmakers have the vehicle to appropriate the needed funding in LD 837. The bill would allocate $3.4 million in state funds to hire more than 100 people to administer the expansion of Medicaid to thousands of poor, working Mainers. The funding would be matched by $6.4 million in federal funds. Delaying Medicaid expansion, as LePage and House Republicans are doing, won’t stop it. Instead, it just makes qualified people wait longer to obtain health insurance so they can visit a doctor, start substance abuse treatment or obtain other needed health services. This is cruel, and, according to Monday’s court ruling, runs afoul of the law. Follow BDN Editorial & Opinion on Facebook for the latest opinions on the issues of the day in Maine.<doc-sep>
AUGUSTA, Maine — A Maine judge on Monday ordered Gov. Paul LePage’s administration to begin implementing voter-approved Medicaid expansion in a massive victory for advocates and a blow to the governor on a core fight of his tenure after the state ignored a key deadline. In a 13-page decision, Superior Court Justice Michaela Murphy cited the Maine Department of Health and Human Services’ “complete failure to act” on part of the law requiring the state to file a plan to expand Medicaid. She ordered state officials to file that plan within a week. Advocates for Medicaid expansion sued the LePage administration in late April after the state missed an April 3 deadline to send a plan — a simple document — to the U.S. Department of Health and Human Services on how it would cover an estimated 70,000 more Mainers with incomes between 101 percent and 138 percent of the federal poverty level. The Republican governor vetoed past efforts to expand Medicaid five times. He kept that tack after 59 percent of Maine voters approved it in last year’s election, repeatedly saying he wouldn’t implement it unless lawmakers funded it at his administration’s disputed cost estimate and without raising taxes or raiding state surpluses. Lawyers for the state argued that LePage couldn’t implement a law that hasn’t been funded by the Legislature. While startup funding has been a priority for legislative Democrats, it is one of many issues held up in a partisan State House feud over a larger spending package. Advocates cited the state’s $140 million surplus. One has said that the governor’s roadblocks were no more than “excuses.” Murphy ruled that she was “not persuaded that the executive branch is excused from clear statutory obligations by the legislature’s failure to follow through with legislative obligations — as defined by the executive branch.” Robyn Merrill, executive director of the progressive Maine Equal Justice Partners, which led the lawsuit on behalf of people who would be covered, said in a statement that voters “did not make a request at the ballot, they passed a law, and laws are not optional.” A LePage spokeswoman said the administration is reviewing the decision. Under the law, the state is supposed to start covering newly eligible Mainers by July 2. However, Democrats have proposed a $10.4 million bill to fund more than 100 state jobs related to expansion and Murphy’s ruling did not weigh in on funding of the law. That could be the new fight over expansion if the ruling stands. For a roundup of Maine political news, click here for the Daily Brief. Click here to get Maine’s only newsletter on state politics via email on weekday mornings. Follow the Bangor Daily News on Facebook for the latest Maine news.