[U] Like My [Now-Delayed] Longish Post On Pricing, I Will Have To Return To This Topic -- In A Few Weeks...

UPDATED — 12.05.2018 @ Dawn: it seems I need not write it up, as this fine blogger, at “xpostfactiod” has a whole entire blog(!) covering these matters, and closely tracks my thoughts, albeit in a more cogent and organized fashion. Do go read all his posts (he wrote a PhD dissertation on a midevil Catholic anchorite, no less!), but start here. [End updated portion.]

I simply don't have the bandwidth to go through all of this in detail, but because I had input on what became Section 1332 of the ACA of 2010, long before it was a final draft stage document (circa early 2006), I am deeply skeptical that the four commands of the statute in 1332 may be effectively eviscerated by a mere "guidance". Certainly a new rule-making, with appropriate notice and comment periods, in the Federal Register -- would be the minimum fair practice, here.

But -- as we've long seen, Trump-World certainly applauds overstepping one's authority (to an astonishing degree), and then daring anyone. . . to challenge the power grab. Ms. Verma -- I suspect -- is on a very short leash here, one held by Trump himself. But if this begins to look more likely to see any definitive adoption in any state, I will return to it. Here is today's presser -- and the October 24 "guidance".

Both look to be beyond the scope of CMS current authority grants, as delegated by Congress. So (for now) here is how Modern Healthcare very cogently frames it:

. . . .First, the new permissions must go through the rulemaking process, said Christen Linke Young, a fellow at the Brookings Institution and former CMS official, in an analysis.

"By releasing the document as guidance, the agencies are implicitly taking the position that it is an 'interpretative rule' exempt from the standard rulemaking process," she said. "However, the new guidance contains policy that would likely be classified under the (federal law) as a legislative rule. As a result, the agency likely cannot adopt these changes without notice and comment rulemaking," Young said.

The distinction is important. Any state looking to implement the ideas could be sued even if the CMS approved their 1332 waiver. . . .

Now you know -- this; and one on the now vanishingly minimal chances of any real pharmaceutical pricing reform, here in the US -- during the quiet week between Christmas and New Years. Onward. Bonus -- another opposition to Trump, just filed, in 18-cv-6810, as well.

नमस्ते