SURPRISE BILLING FIX REGAINING TRACTION?
Legislation to address unexpected bills for out-of-network medical care appears to be making a comeback, after a committee turf battle stalled its progress at the end of last year.
House leaders want to pass a bill by May, when they intentionally created a deadline for several popular health programs that will need congressional reauthorization. Leaders hope to drive action on surprise billing and prescription drug costs in May.
House Ways and Means Chairman Richie Neal, D-Mass., plans this week to release his committee’s bipartisan legislation. Neal says the committee will vote on its bill Feb. 12. The plan relies on outside mediation to settle billing disputes; a competing plan from the House Energy and Commerce Committee uses a benchmark payment rate.
Leaders are pressing the House to overcome differences and find consensus. The issue also pits two of Washington’s most powerful healthcare lobbies against each other: hospitals and doctors favor the Ways and Means approach, while insurers support the benchmarking plan.
Further complicating the issue, House Education and Labor Chairman Bobby Scott, D-Va., this week said his panel plans to take up its own legislation. Little is known about what that plan might look like, but Scott also said he would like to work with Senate HELP Committee Chairman Lamar Alexander, R-Tenn. Alexander supported the Energy and Commerce plan and pressed for its inclusion in catch-all spending legislation last month.
Despite these complications and powerful competing interests, optimism is growing that Congress will find consensus by this spring. Democrats and Republicans want to solve the problem, and President Donald Trump has also pressed for a legislative fix.
ALARM AS CORONAVIRUS DECLARED PUBLIC HEALTH EMERGENCY
Concern on Capitol Hill is growing over the spread of China’s coronavirus outbreak, as Health and Human Services Secretary Alex Azar on Friday declared a public health emergency.
The House Foreign Affairs Asia Subcommittee will hold a hearing Wednesday titled “The Wuhan Coronavirus: Assessing the Outbreak, the Response, and Regional Implications.” Witnesses include Jennifer Nuzzo, an associate professor at the Johns Hopkins Center for Health Security; Jennifer Bouey of the RAND Corp.; and Ron Klain, who coordinated President Barack Obama’s Ebola response in 2014.
Lawmakers also want to know how the Homeland Security Department is responding to the threat. Senate Homeland Security Committee Chairman Ron Johnson, R-Wis., and Ranking Democrat Gary Peters, D-Mich., last week wrote to Acting Secretary Chad Wolf inquiring about the administration’s response, as did the Democratic leadership of the House Homeland Security Committee.
Congress should be prepared to provide additional funding if the administration needs it, according to at least one key appropriator.
Rep. Tom Cole, R-Okla., said he believes such an effort would have broad support. But Cole also voiced confidence in the Centers for Disease Control and Prevention’s ability to respond to the outbreak. Cole is the top Republican on the Appropriations subcommittee that funds the Health and Human Services Department.
LAWMAKERS SEEK TRUMP PUSH ON DRUG PRICES IN STATE OF THE UNION
Healthcare will be a significant topic in President Donald Trump’s State of the Union address Tuesday, and key Republicans want him to focus on legislation to lower prescription drug costs.
Senate Finance Committee Chairman Chuck Grassley, R-Iowa, continues to hope Trump will put more of his weight behind Grassley’s bill with Ranking Democrat Ron Wyden, D-Ore. Grassley’s team is working with the White House on the speech, according to reports.
One key to watch will be what Trump says about his administration’s International Pricing Index proposal, which White House officials are now internally calling the “most favored nation” plan. The proposal to tie drug prices to prices in foreign countries is anathema to most conservative groups and Republicans on Capitol Hill generally do not support it. But the White House has the plan ready whenever Trump decides to roll it out, and he is apparently eager to do more on drug prices and other health issues.
Meanwhile, the House Ways and Means Health Subcommittee will hold a hearing Wednesday titled “More Cures for More Patients: Overcoming Pharmaceutical Barriers.” Little information is available on the substance of the hearing, but subcommittee Chairman Lloyd Doggett, D-Tex., is among the pharmaceutical industry’s fiercest critics in Congress.
DEMOCRATS OPPOSE TRUMP MEDICAID PLAN
The Trump administration last week released a new plan to allow states to receive a set amount of Medicaid funding, rather than the open-ended funding they current receive. Democrats are acting swiftly to show their disapproval.
The House on Thursday will vote on a resolution of disapproval of the plan, which the Centers for Medicare and Medicaid Services rolled out, led by Administrator Seema Verma.
So-called block grants in Medicaid are a long-cherished policy goal for conservative health policy experts. Conservatives believe a set funding level would cause states to better constrain costs in the Medicaid program – and in exchange, states would face fewer rules from Washington in how they run their programs.
Democrats sharply disapprove of the approach. Reps. Joe Kennedy, D-Mass., and Jim Cooper, D-Tenn., led dozens of their colleagues in writing to Verma and Health and Human Services Secretary Alex Azar. They questioned the change on both moral and legal grounds. “If the Trump Administration chooses to unleash this dangerous plan tomorrow, it will only underscore the flagrant disregard they have for the health of the American people. Along with our colleagues, advocates, experts and patients, we will continue to make clear that any effort to steal Medicaid coverage from deserving Americans is not only immoral, it’s illegal,” Kennedy said.
The plan also faces resistance from the biopharmaceutical industry. Currently, drugmakers provide large discounts for Medicaid patients – in exchange for Medicaid plans including all FDA-approved products on their formularies. One way that states could gain flexibility under the block grant proposal would be to limit formularies. The Biotechnology Innovation Organization said the industry “will do everything we can to ensure patients have access to the medicines they need and will weigh all of our options as this process unfolds.”
Ultimately, Democrats will not be able to stop the plan themselves – the resolution will pass the House this week but likely not even receive consideration in the Republican Senate. But the administration and states that choose to adopt the new funding method are likely to face legal challenges, as Kennedy and Cooper allude to in their letter.