Mariam Eatedali Comments on What to Expect in Healthcare When Congress Returns

August 28, 2019

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Congress returns from recess in September, and plans to address a number of healthcare issues including surprise billing, drug pricing and the Cadillac tax.

In an Aug. 27 article for Fierce Healthcare, McGuireWoods Consulting research associate, Mariam Eatedali, gave an overview of what to expect on pending healthcare legislation.

“How to address the amount that will be paid as part of a ‘surprise bill’ remains controversial,” Eatedali noted. “Those opposed to benchmarking payment for out of network bills say that it is essentially price setting and raises concerns about access to care in rural areas.”

Arbitration, or independent dispute resolution (IDR) allows for the negotiation of payments for each individual between healthcare providers and insurance companies.

In the House, the Energy and Commerce Committee reached an agreement to amend the benchmark rate by creating a hybrid solution, but the Education and Labor Committee also has jurisdiction over surprise billing and could markup its own version of the legislation. The Ways and Means Committee has stated they may want to do their own bill as well.

In the Senate, the Lower Health Care Costs Act includes a provision on surprise billing, but was blocked from being considered in the Senate because of concern about the benchmark approach.

Legislation around lowering drug pricing is another healthcare issue that will be addressed post-recess. The Senate Finance Committee favorably reported the Prescription Drug Pricing Reduction Act before the recess, and this bill will most likely be married with legislation from other committees.

“At the committee’s mark up, it was clear that a number of members wanted to address additional issues in drug prices,” Eatedali said. “When the legislation comes to the Senate floor, many amendments can be expected.”

The House passed a drug-pricing transparency bill, and there is a companion bill in the Senate which will likely go through additional changes before moving to the Senate floor. House Speaker Nancy Pelosi (D-CA) is leading the effort on draft legislation that allows Medicare to negotiate lower drug prices, but the bill has not yet been released.

Finally, the Cadillac tax will receive a lot of attention once Congress returns. Originally part of the funding of the Affordable Care Act (ACA), the tax is an excise tax on health plans to be paid by insurers on employer-provided health insurance plans that cost more than $11,200 per year for individuals and $30,100 for families.

“Once supported by ACA backers, the tax has been controversial. Labor Unions were strong opponents of repeal. However, unions are now saying that the benefits they sought to protect are disappearing and are concerned with the rise in premiums,” Eatedali said.

The repeal passed 419-6 in the House before the recess, and a companion bill in the Senate has 61 cosponsors. Senate Majority Leader Mitch McConnell (R-KY) has yet to make a decision on whether the bill will be brought to the floor for a vote.