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President Joe Biden signed a comprehensive health care bill into law on Tuesday, heralding the biggest change to federal health care policy since the Affordable Care Act of 2010 was passed.
The Inflation Reduction Act will make a big difference, especially for seniors and Medicare patients, who are Oak Street Health’s primary patient populations. This limits Medicare Part D prescription drug copayments to his $2,000, eliminates Part D prescription drug copayments for vaccinations, and sets a $35 monthly cap on insulin for Medicare customers. To do.
The IRA will also expand low-income subsidies to individuals in 2024. We have incomes up to 150% of the federal poverty level, which is currently about $20,385 per household.
Ali Khan, chief medical officer of Oak Street Health, spoke to Healthcare Dive about the impact the IRA will have on patients west of Chicago, what health policy we expect next, and next steps for primary care companies. I heard.
This interview has been edited for clarity and length.
Healthcare dives: What are you most looking forward to about an IRA and how will it affect your patients?
Ali Khan: The patients we serve, like seniors and other Medicare recipients, today have to make some pretty tough choices between paying for medicines and meals or paying other bills. No. So this is really a home run on drugs first and foremost.
I think drug affordability is a huge issue for many people, but especially for the working class, income-constrained seniors, and other patients we serve on Oak Street. is. For my patient on the west side of Chicago, capping her $2,000 on out-of-pocket drug costs for any given year is a huge update.
And by limiting the cost of insulin to $35 a month, Medicare patients will have access to a much-needed drug. We hope this will spur national efforts to bring insulin costs under control for all. Avoid foot infections and amputations. Setting a cap is at least the first step, as patients with unstable income can budget. So providing more structure and consistency here is a real boon.
Given that Oak Street’s primary patient population consists of the elderly and Medicare patients, what impact do you expect the IRA as a whole to have on Oak Street’s health?
Clan Chief: One of the things I’m very excited about is extending low-income subsidies to more seniors. A patient I work with on the west side of Chicago has to make a choice between paying for a refrigerator that stores insulin, paying for insulin, or paying for foods that require insulin to aid digestion. I’m really struggling. .
Too many people are just above the line to qualify for additional help. This change would be life-saving because there is now a low-income subsidy that applies to a certain percentage of people close to 100% of the federal poverty limit. But above 125%, it will be phased out and completely retired. Making it 150% for low-income subsidies is a huge number of people who would otherwise be locked out.
What healthcare issue would you like the government to address next?
Clan Chief: Medicare and Medicaid Service Centers in particular are doing some very interesting research looking at ways to address social risks. People living in highly vulnerable communities are the communities hardest hit by the pandemic.
We are starting to see new policies from CMS that recognize underlying inequities across communities and ask how the federal government encourages investment in those communities.
At Oak Street, we’ve been thinking about addressing these issues for years. So could CMS changes create momentum to apply what we’re doing now in Oak Street across the country to our 60+ million Medicare subscribers? The fact that this has entered a national debate and we see bold proposals here is very encouraging to me.
There has been a lot of interest in primary care companies since CVS announced its acquisition plans and Amazon announced it would buy One Medical for $3.9 billion. How is that interest changing the landscape for primary care providers like Oak Street?
Clan Chief: All in all, this is proof that we’ve all been on the right track.
It is also the recognition of the opportunity to hit. Amazon sees a big opportunity in primary care. They don’t see it as a situation to try to buy out a large group of doctors. This is not a private his equity commitment. It’s a venture capital game.
One Medical has a different patient population than Oak Street, so it’s clear there are some things I believe in when it comes to health equity and reinvesting in our communities.
But I think there are still big milestones in the industry. And in terms of how primary care will lead the way and how American health care will fundamentally change, it’s a real promise of what will happen if we all do this right.