4 Autumn Predictions for Congressional Healthcare Agenda
By - In a personal interview with RevCycleIntelligence.com, Joel White, President of the Council for Affordable Health Coverage, presents four key congressional healthcare agenda items that he says have a fair shot of reaching the president this Fall.
White — who previously chatted with RevCycleIntelligence.com about how King v. Burwell addresses the affordability crisis following the Supreme Court’s decision to uphold subsidies — says there are no guarantees such predictions will come true when it comes to dealing with over 500 different decision-makers. Nonetheless, healthcare is an incredibly hot topic because of its widespread prevalence online across mainstream news outlets, he says. “Whether about must-pass, end-of-year annual budget bills, the Planned Parenthood controversy, prescription drug prices, precision medicine, meaningful use and interoperability, or changes to and open enrollment for Obamacare, health care headlines are sprawled across newspaper and web pages,” explains White.
The following is White’s full commentary as per email conversation with RevCycleIntelligence.com.
1: Reconciliation
"Earlier this year, both the House and Senate agreed to a budget resolution that authorized the use of a tool known as reconciliation," says White. "Under this process, legislation that saves money can be fast tracked in both the House and the Senate, and only requires a majority vote in the upper chamber. So instead of 60 votes, the Senate only needs 51 votes to pass legislation. This is how the controversial Affordable Care Act was sent to the president," White states.
"This year, we expect both the House and the Senate to use reconciliation to muscle through changes to Obamacare, including repeal of the individual and employer mandates, striking the Independent Payment Advisory Board, changing auto enrollment in health plans, and, yes, defunding Planned Parenthood. While we expect both the House and the Senate to pass this legislation, it is highly unlikely the president will sign it into law," he adds.
2: Medicare
"While reconciliation may not produce a law, Congress will almost certainly pass, and the president will sign, legislation to avert a massive increase in Medicare beneficiaries' premiums. Medicare currently requires most beneficiaries to pay a part B premium that is pegged at 25% of the total cost of the program. Part B pays for most outpatient services," White says. "When no Social Security cost-of-living increases are paid, premiums stay flat for most beneficiaries, which will happen for about 70% of seniors and the disabled in 2016," White maintains.
"The other 30% currently face a 52% premium hike starting January 1. This is because they are new beneficiaries, do not claim Social Security, or are higher income. Congress desperately wants to avoid this premium shock. We expect a fix, one that will carry other pieces of legislation favored by members of Congress. This may include changes to a host of payment systems, but especially those for hospitals and post-acute care. Hello Christmas tree," says White.
3: Affordable Care Act
"We continue to believe that Congress will pass and the president will sign several pieces of legislation that address real problems being faced by individuals and small businesses. These bills will directly address expected cost increases primarily in the small group market, as well as new red tape and bureaucratic reporting requirements that are increasingly becoming headaches for bureaucrats and consumers alike," White explains. "Surprisingly, we expect broad bipartisan support for this legislation," he says.
White highlights three specific changes to be expected:
a: Small Group Market Definition
"Beginning in 2016, a technical provision in the ACA will change the definition of the small group market to include employers with up to 100 employees -- an increase from the current definition of up to 50 employees. This change will force many companies, which have historically been defined as a 'large group,' into the 'small group market,' says White.
"According to an Oliver Wyman analysis, premiums could increase by 18 percent as a result. CAHC supports the Protecting Affordable Coverage for Employees Act (H.R. 1624/S. 1099). This bipartisan, common-sense legislation would provide states with flexibility to increase the small group market from 50 to 100 if they choose, but remove the requirement that forces states to change the small group definition," White maintains.
b: Allow small businesses to continue to offer HRAs for their employees
"Many small business owners reimburse employees for medical care and services through Health Reimbursement Arrangements (HRAs). Beginning July 1, 2015, small businesses who do not offer a group health plan with the HRA will be fined $100 per day, per employee," White explains. "That totals $36,500 per employee up to $500,000 in total, or 18 times more than the $2,000 employer mandate penalty for not providing any coverage. These small businesses are trying to help their workers, but the IRS rules say their effort is not good enough," he says.
"As a result, these businesses will not offer any assistance, and employees will lose. CAHC supports the Small Business Healthcare Relief Act (H.R. 2911/S. 1697), bipartisan legislation that would allow small businesses to offer HRAs to employees for the payment of premiums or qualified medical expenses associated with insurance coverage without facing an outrageous fine," states White.
c: Simplify onerous and time consuming reporting requirements
"New regulations under the ACA require businesses to report very detailed and specific information about the health insurance coverage offered to employees and any potential sources of other coverage to the IRS, including information the employer may not possess or even need to access otherwise," White explains.
"Small businesses simply do not have the resources and personnel to dedicate to these types of time-consuming compliance matters. CAHC supports the Commonsense Reporting and Verification Act of 2015 (H.R. 2712) and the Commonsense Reporting Act of 2015 (S. 1996), bipartisan bills that would reduce reporting burdens on small businesses by streamlining the process," says White.
"The bills would create a voluntary prospective reporting system and simultaneously take steps to improve the privacy of individuals and families. Under this system, small employers could voluntarily report pertinent information about their health plan offerings for the current year to the IRS," maintains White.
"A process would also be established for the appropriate agency to contact the employer should more specific employee information be required. In addition, the measures require a General Accountability Office (GAO) study on the functionality of the prospective reporting system, including the accuracy of information collected, the number of employers electing to report, and any challenges that occur," White adds.
4: The innovation agenda
"This summer, the house passed a bill known as 21st Century Cures. We expect the Senate to introduce and take up a similar bill before the end of the year. We are hopeful that the Senate will vote on this measure in 2016. The bill creates new incentives to discover and develop innovative products that treat and cure diseases. Because these products are often prescription drugs, the legislation may get caught up in the politics surrounding prescription drug prices," White says.
"But we think there's enough excellent material, not to mention a $10 billion funding increase for the NIH, on the table to spur congressional action," White says. "This legislation may be the moving vehicle that finally requires electronic health records and mobile apps to interoperate and share information — which will improve patient care."
