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Federal Focus

Health Care Policy Update – October 2019

With a divided Congress and an impeachment inquiry underway, most expect little compromise to occur in Washington, D.C., but there are a few exceptions.  The first area of compromise occurred when President Trump signed a bill to fund the government through Nov. 21.  The House and Senate continue to negotiate full appropriations for the rest of FFY2020. The policies potentially tacked onto the budget deal continue to be of high interest to stakeholders.

Although the 2020 election is still a year away, the campaign cycle has begun.  There are currently 19 Democrats and four Republicans, including President Trump, competing for president. In the Senate, 33 seats are up for election, and in the House all 435 seats are up for election. In the 2018 mid-term elections, voters made it clear health care is an important issue to them, and it remains the top priority for voters approaching the 2020 election. Voters remain frustrated with high drug prices, growing out-of-pocket expenses, and inadequate health insurance benefits.  Democrat plans vary from Medicare for All to creating an optional public plan to building upon the Affordable Care Act.  With no Republican willing to openly challenge Donald Trump, the president has felt little pressure to get specific about his future health care plans.

House Speaker Nancy Pelosi announced a formal impeachment inquiry of President Trump on Sept. 24.  The impeachment inquiry was sparked by a whistleblower who revealed Trump asked Ukraine’s new president, Volodymyr Zelenskiy, on a July telephone call to investigate former Vice President Joe Biden’s family. Biden is a leading Democratic contender for the 2020 nomination, although Elizabeth Warren is making some inroads.  Six House committees including the Judiciary and Oversight panels are meeting to determine if there is enough evidence to consider writing articles of impeachment.

Disproportionate Share Hospital (DSH) Cuts

Congress cut Medicaid DSH payments in the Affordable Care Act with the thought that hospitals would care for fewer uninsured patients as health coverage expanded.  Hospitals continue to care for a large number of uninsured patients because the projected increase in coverage has not fully come to fruition and because 14 states have declined expanding Medicaid to date. Medicaid DSH cuts have been delayed numerous times, but are scheduled to go into effect Nov. 22. If the budget is extended through another Continuing Resolution (CR) we would expect DSH as well as other extenders to be delayed as well.  The House already overwhelmingly passed a DSH extension.

Surprise Billing

The Senate and House are considering legislation to address surprise medical bills patients incur. Surprise medical bills often are in the form of an out-of-network physician caring for someone using in-network hospitals.  The Senate Committee on Health, Education, Labor and Pensions (HELP) passed the Lower Health Care Costs Act of 2019 to focus on reducing health care costs.  The bill would hold patients harmless from surprise medical bills, but use a benchmark rate to resolve payment disputes between plans and out-of-network providers. Senate HELP leaders have indicated they are working with committee members on potential changes before a floor vote. The House Energy and Commerce Committee approved the No Surprises Act in June.  The legislation would prohibit balance billing for out-of-network emergency services and certain out-of-network ancillary and post-stabilization services, and set reimbursement for out-of-network providers at the median in-network contracted rate for services in the geographic area. It also includes a voluntary arbitration process for hospital and physician claims with median in-network reimbursement of $1,250 or more.  Given the political disruption, this issue as well as many others may not pass.

Drug Pricing

The United States’ spending on prescription drugs increased by 28 percent from 2011 to 2016 which makes it hard for politicians to ignore constituent anger over the prices of life-saving medicines they can’t afford. Unlike most issues in Washington, D.C., lowering high prescription drug costs has bipartisan support and the potential for achieving positive change.  There is consensus around the idea that any savings from proposals should be driven back into the Medicare program by offering beneficiaries an out-of-pocket limit on their spending on drugs.  Bills are unlikely to move through the process until 2020. 

Other 2020 Priorities

  • 340B
  • Graduate medical education
  • Pricing transparency

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Page updated 10/23/19

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