2019 Bipartisan Pushes Expected on Transparency, Surprise Billing

Partisan bill pushes in the next Congress could identify the healthcare policy directions that would take hold the next time either party controls both chambers.

Dec. 20—The newly divided Congress is expected to agree on little about healthcare policy, with the likely exceptions of legislation to require greater transparency and to address surprise bills, according to a legislative tracking firm.

In 2019, Congress will shift from Republican control of both chambers to Democratic control of the House of Representatives, with Republicans retaining control of the Senate. The two parties have widely divergent healthcare priorities, but common ground is likely on a few narrow issues.

“There is broad agreement in principle at least that more price and quality data should be publicly available and more consistent across different types of providers,” said Brian Kearney, principal for the law and policy advisory group at Mercer.

Among the congressional leaders focused on the issue are members of the Senate Health, Education, Labor and Pension (HELP) Committee, he said in a recent media briefing.

“The cost of health care has remained in a black box,” Sen. Lamar Alexander (R-Tenn.), chairman of the HELP Committee, said at a September hearing on the issue. “In the charge for making healthcare information more easily available, the federal government can also play a role.”

The cost transparency focus of Congress in 2019 will include action on drug prices, which is another area of bipartisan agreement, Kearney said. Areas of common ground include increasing price transparency, requiring drugmakers to justify prices, and speeding up approvals for new treatments.

“And even if a bipartisan deal in Congress doesn’t materialize, the Trump administration is going to keep on moving to lower prices through regulations, as we have seen,” Kearney said. “They have a lot of authority to do this, particularly in public programs. And they look intent to remain active on this issue.”

The recently issued 2020 Medicare Advantage and Part D Drug Pricing proposed rule would require Part D plans to increase transparency and provide enrollees and physicians with a patient’s out-of-pocket cost obligations for prescription drugs when a prescription is written. Additionally, the Centers for Medicare & Medicaid Services recently launched the Procedure Price Lookup tool, which displays national averages for the amount Medicare pays the hospital or ambulatory surgical center and for the copayment that a beneficiary with no Medicare supplemental insurance would pay the provider.

Surprise Bills

Surprise medical billing, or balance billing for out-of-network care, also is expected to be a key focus of the new Congress.

“It’s pretty clear that the next Congress is going to take up legislation to prevent out-of-network surprise medical bills,” Kearney said.

A growing number of state laws already bar or limit balance billing, and federal legislation under development would likely apply to most group health plans, including self-funded plans, and individual coverage, Kearney said.

For instance, a Democratic bill called the No More Surprise Medical Bills Act would create a “binding arbitration” process to determine the appropriate provider payment rate in surprise out-of-network billing scenarios.

A bipartisan bill, the Protecting Patients from Surprise Medical Bills Act, is in draft form. Provisions would limit patient cost-sharing to the amount the patient would owe an in-network provider and prohibit providers from engaging in balance billing.

“If this legislation is not well-drafted, it could raise costs and make it tougher to design networks that are attractive to providers and patients,” Kearney said.

Nine health plan, employer, and consumer organizations recently proposed guiding principles for federal legislative action on surprise medical bills. Their recommendations began with the premise that patients should be protected from such bills.

Leading hospital advocates issued a statement in response that agreed on the need to eliminate surprise bills but laid the blame at the feet of insurers and increasingly common narrow networks.

“The hospital community wants to ensure that patients are protected from surprise gaps in coverage that result in surprise bills, and we look forward to working with policymakers to achieve this goal,” wrote Rick Pollack, president and CEO of the American Hospital Association, and Chip Kahn, president and CEO of the Federation of American Hospitals.

“This is going to be an important issue to watch next year,” Kearney said.

Another healthcare finance issue that has drawn bipartisan efforts is the push to repeal the so-called Cadillac tax on high-cost insurance plans. The 40 percent excise tax on high-cost employer-sponsored plans was created by the Affordable Care Act, but its implementation was delayed until January 2022.

Kearney expected Congress to push for a repeal as soon as the spring as part of budgetary legislation and negotiations on raising budget caps.

Partisan Measures

Congress also is likely to act on a range of partisan health policy matters that may advance in one chamber but die in the chamber controlled by the other party. However, such bills may indicate healthcare policy directions that could take hold the next time one party regains control of both chambers.

For example, health savings account (HSA) tax changes backed by Republicans likely will languish in the next Congress but return in a future version, Kearney said.

In the meantime, the Treasury Department and IRS could make administrative changes to the definition of preventive care, which could have big implications for health insurance coverage.

Democrats are expected to advance legislation to modestly expand the ACA. Republicans are expected to reject those changes, in part due to their large cost.

Democrats also are expected to advance partisan legislation to roll back the Trump administration’s regulatory decisions on health care.

The lack of success with such limited efforts likely will lead Democrats to focus on more expansive efforts, such as the Medicare for All Act, which would outlaw employer-sponsored plans, Kearney said. Although such legislation will not advance in the Senate, prominent Senate Democratic supporters will make it a litmus test for presidential candidates, he said.

Incoming House Speaker Nancy Pelosi (D-Calif.) is expected to prioritize proposals to allow people 50 and older to buy in to Medicare.

“It’s highly unlikely anything like this will pass in the next couple of years, but it will be interesting to see if Democrats have any better luck in coalescing around a unified agenda than Republicans did ahead of 2020,” Kearney said.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare