With the impeachment drama out of the way Congress really got down to business this week. Health care is the number one issue on the minds of voters as we head toward the November elections and Congress knows it.
Health care for seniors is also one of the top issues on our agenda at TSCL and we have been talking to Congressional offices about our concerns. That's why we were happy to see progress this week regarding the issue of surprise medical billing. Surprise billing has been a real problem for some seniors who have Medicare Advantage. It's an issue that TSCL has been discussing with Congress and that we've written about for the last few weeks.
If you've received a medical bill for services that you thought were covered by your health insurance you already know what surprise medical billing is. But as a reminder, “Surprise medical billing” is a term commonly used to describe charges received by someone who has health insurance but they received care from a health care provider who is not included in their insurance coverage. This situation could arise in an emergency when the patient has no ability to select the emergency room, treating physicians, or ambulance providers. Surprise medical bills might also happen when a patient receives planned care from an in-network provider (often, a hospital or ambulatory care facility), but other treating providers brought in to participate in the patient’s care are not in the same network. This can end up costing patients thousands of dollars they thought their insurance would pay.
As we've found out in our meetings with Congressional staff members, Congress is hearing thousands of complaints from voters who want surprise billing stopped. But, they are also hearing from the health care providers who are making a lot of money from surprise billings and they are fighting back to try and stop or modify legislation. Because of the pressure Congress is receiving from opposing sides, getting legislation to fix the problem is more complicated than you might expect. There are four bills in the Senate to deal with the issue and five in the House.
However, support in the House has gone to two bills of the bills, both of which moved forward this week: HR 5826, sponsored by Rep. Richard Neal (D-MA), Chairman of the House Ways and Means Committee; and HR 5800, sponsored by Rep. Bobby Scott (D-VA), Chairman of the House Education and Labor Committee. While they each deal with the same issue the way they try to solve it is different.
The Neal bill was passed by the Ways and Means Committee on Wednesday of this week. It would ban surprise billing using an arbitration process favored by hospitals and specialty physician groups but opposed by insurers, employers and labor unions. Neal’s legislation would send all the disputes that can’t be settled between the parties to arbitration but require mediators to consider median contracted rates used by health plans, with the mediators prohibited from considering “usual and customary charges,” also known as “billed charges.”
The prices that insurers pay for in-network services are typically much lower than the provider list prices.
The Scott bill passed the Education and Labor Committee on Tuesday of this week. It has a different approach for dealing with surprise bills that limits the arbitration process and sets forth a benchmark payment rate. Scott’s bill would force doctors to accept a benchmark rate for bills under $750 and go through arbitration in disputes over bills higher than $750.
The approach taken in the Scott bill is also the approach favored in the Senate bills. Ways and Means Chairman Neal said they will start negotiating a compromise between the two House bills that will also be agreeable to the Senate and he is optimistic they can reach a solution soon. This approach is opposed by conservative groups such as the National Taxpayers Union, which have opposed what they call “rate-setting.”
TSCL will continue to keep the pressure up on Congress to get this problem solved as soon as possible.
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Also this week, Senate Finance Committee Chairman Charles Grassley (R-Iowa) expressed optimism that he will gain support for the bill to lower prescription drug prices that he and Senator Ron Wyden (D-Ore.) have written. Grassley's remarks came in the light of President Trump's State of the Union speech where he thanked Grassley for his work on the drug price issue and urged Congress to get a bill passed and sent to him.
The bill, known as the Grassley-Wyden bill, would create a rebate system in Medicare Part B and Part D beginning in 2022 for brand-name drugs and biological products with prices that increase faster than inflation. Conservative groups and some Senate Republicans have opposed the rebate system for Part D, the prescription drug benefit program, but not for Part B, the outpatient services program.
As we have written recently, Grassley's main problem in getting his bill passed in the Senate is opposition from his fellow Republicans. Grassley said he needs at least 25 Republican co-sponsors to get his bill (S. 2543) to the floor of the Senate for a vote. Ten Republicans other than Grassley have so far made public shows of support for the legislation.
Senate Majority Leader Mitch McConnell (R-Ky.) has indicated he will not bring the bill up for a vote until he knows there are enough Republicans who support it so that it can pass.
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In case Congress is not able to come to an agreement concerning legislation to lower prescription drug prices, there are reports that President Trump is considering executive action to cut drug prices ahead of the 2020 election as he enters his re-election seeking to rebut Democratic criticism that his policies have hurt U.S. health care.
If he proceeds, Trump would force drug companies to accept lower payments from Medicare for treatments administered in doctors’ offices. The rule would apply to certain drugs bought by the “Part B” section of Medicare.
Under the rule he’s considering formally proposing, Trump would order reimbursement for certain Part B drugs to be tied to what’s known as the International Price Index. That would mean a price cut for many medicines, since the prices drug makers charge outside the U.S. are often set by government-run health-care systems and are generally lower. Medicare doesn’t use its position as a big buyer of drugs to bargain for lower prices.
Officials working on the plan have not yet settled on many of its details. The Trump administration first proposed the approach in 2018. Three officials familiar with the matter said it remains under consideration and has not been ruled out, despite Trump’s endorsement for the Grassley-Wyden bill.
The drugs that would be affected by any Trump action are among the costliest taken by Americans. They include innovative therapies for cancer, immune disease and other disorders. The industry says that Part B pharmaceutical spending makes up just 3% of overall Medicare costs.
The pharmaceutical industry warns the move could damage its profits and take away incentives to invent new treatments.
However, taking this action would cause at least two difficulties for the President. Signing legislation to reduce Medicare spending on the drugs would generate official budget savings that Congress could have applied to other health-care legislation -- bills to expand insurance coverage or reduce other drug spending, for example. Executive action taken before a bill’s passage would remove a key bargaining chip, and likely reduce the scope of a health-care bill expected in the coming months.
The president might also hurt himself on the campaign trail. Linking prices paid by Medicare to an international index that includes countries with nationalized or government-run health-care systems would undercut one of Trump’s favorite criticisms of Democratic proposals: they represent “socialism.”
For progress updates or for more information about these and other bills that would strengthen Social Security and Medicare programs, visit the Bill Tracking section of our website or follow TSCL on Twitter.