Top Healthcare Policy News from the week of January 6, 2020

Policy  |  2020 Election Update

Latest Healthcare Election News

• Political Risk: A reported by Axios, if the ACA is repealed, Trump might lose out big time politically because the most affected states are ones that typically swing presidential elections.

On to the Democrats.

• Read a summary of Democratic candidate healthcare positions here.
• Andrew Yang: Read his healthcare plan.
• Elizabeth Warren: Shifted her rhetoric to emphasize voter ‘choice’ in healthcare insurance plans. She thinks that once her public option 100 day plan gets a trial run, voters will choose it over private options.
• Joe Biden: Is a “healthy, vigorous” male at age 77. Good for him.
• Michael Bloomberg: Joins the Public Health Option bandwagon

• Policy Lingo: What’s a “Public Health Option” all these candidates are talking about?

• From the Debate: Candidates wondered whether Medicare for All is realistic, but healthcare wasn’t discussed much at this one.

Policy  |  Healthcare Spending Bill

Things You Should Know

Spending Bill Surprises: A recap of all of the healthcare policies changing in Congress’ $1.4 trillion spending bill.

• ACA tax repeals
• Tobacco age to 21
• More U.S. HIV funding
• Promote generic drug competition
• Gun violence funding
• Suicide prevention funding
• Extending DSH payment delays
• Funding U.S. territory Medicaid services
  • Read more on the spending bill here

More on those healthcare tax repeals…

• The U.S. spending deal repealed insurance and medical device taxes.
  • According to a non-partisan analysis, those repeals are expected to decrease tax revenues by $373 billion over the next 10 years. Remember that these taxes weren’t ever in effect – but would have phased in in 2020 or soon thereafter.

Conspicuously missing from the spending bill…

• Two major Congressional healthcare agenda items were left out of the December spending bill: surprise billing and drug pricing legislation. So let’s touch on the state of surprise billing next.

Other Trump things:

• Organ Donors: The Trump admin is interested in increasing organ donations.
• Drug Importation: Read about Trump’s plan to import prescription drugs from Canada. The pilot will allow states to import medication for certain types of drugs. To ensure quality, drugs will be retested and relabeled. Canada isn’t really a fan of this plan, so that could be a major hurdle here…just maybe.
  • I should note that HHS released a report estimating the potential savings from this plan…except they left a blank table (page 5) where the estimates should have gone. Meaning they have no idea what the true impact will be.

Seema Verma: The CMS head might just be miserable to work with.

ACA  |  Supreme Court

Big ACA News: Appeals Court Decides Individual Mandate is Unconstitutional

Last week’s edition touched on the ACA case involving whether the individual mandate (AKA, you better have insurance or face a fine) was constitutional, and whether that made the whole ACA unconstitutional.

• This week, an appeals court officially struck down the individual mandate. HOWEVER, they left the decision of the legality of the ACA up to the court that made the original ruling.

Bottom Line.

Most experts think that the ruling is on faulty footing. They argue that the individual mandate was removed in 2017 with Trump’s tax cut, and the ACA continued on, business as usual. Anyway, see you guys in the Supreme Court. That case will be expected to hit in late 2020 – which means healthcare will stay front and center during Election 2020.

• Read more: HHS’ and healthcare groups’ responses to the news.

Legislation  |  Surprise Billing

Surprise Billing to Continue into 2020, and Other Things to Know

• Surprise billing is sort of moving in the right direction. Even though Congress missed on a solution this year, tangible proposals are taking shape, and I wouldn’t expect 2020 to pass by without a bill.

Sides of Surprise Billing.

What does everyone want?

• The AMA (Providers): Wants independent dispute resolution, AKA arbitration, for out of network emergency bills. For bills lower than the $750 threshold, they want payment higher than the median in-network payment rate for that region. They claim that payment data from insurers are skewed, so setting payment at the median might not be accurate.
• The AHA (Hospitals): Has a similar viewpoint to the AMA.
• The AHIP (Insurance): Feels the opposite way. They want a “fair” market-based reimbursement standard for out of network bills. And they’re NOT fans of arbitration.
• The People want no surprise bills.

How does surprise billing affect us?

Glad you asked. Higher out-of-network spending raises overall healthcare costs, which leads to you and me paying higher premiums on our insurance. See for yourself.

• A Health Affairs analysis estimated that getting rid of surprise out of network billing for just 4 types of physician specialists could save $40 billion a year.

What’s next up? Another try this spring.

CMS |  Payments

2020 Site Neutral Payments are Happening

A federal judge decided not to halt CMS’ plans to introduce site-neutral payments in 2020.

Here’s a general timeline of the site neutral stuff:

• -CMS implements site neutral payments for 2019.
• -Hospitals sue.
• -Hospitals win because site neutral policy isn’t budget neutral.
• -Despite losing, CMS implements site neutral payments for 2020.
• -Hospitals sue, saying that they just won this same case for 2019.
• -Hospitals lose for now – the federal judge decides not to intervene for 2020.
• –Up next: hospitals will appeal sometime in 2020.

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