Slim chances of major health care legislation passing this year

By Susan Rupe

Health care affordability is a top priority for Washington lawmakers, but election-year politics, the Senate filibuster and a slim Republican majority cloud the outlook for passage of any major health care legislation this year.

Geoff Manville, partner with Mercer’s Law and Policy Group, gave a rundown of what Congress is doing to address health care issues during a recent webinar.

“Despite all the partisan acrimony, Congress is still focused on health care affordability,” he said. “A ton of bipartisan work is happening on legislation that largely aligns with employer health care priorities – themes of price transparency and costs. This work will continue into the next Congress regardless of party control.”

Even though Congress has been largely gridlocked, numerous employer-friendly health care reforms have broken through to become law, Manville said, including:

Pharmacy benefit manager reforms. Extensive disclosure of business practices to plan sponsors and the government. Complete pass-through of rebates, fees and alternative discounts to group health plans. Requiring PBMs and third-party administrators to disclose direct and indirect compensation to plan fiduciaries. Delinking PBM compensation from list drug prices in Medicare. Banning “spread pricing” in Medicaid and the commercial market.
Price transparency. Codifying rules requiring disclosure of out-of-pocket costs and negotiated rates to plan members and beneficiaries. Ensuring plan sponsors can obtain cost and quality data from vendors. Mandating government reports on price transparency rules, whether they should be harmonized and the feasibility of quality metrics.
Provider and hospital billing reforms. Barring contract terms that prevent steerage to higher-value, lower-cost providers. Requiring hospital off-campus outpatient department to provide a unique identifier on Medicare bills. Banning hospital facility fees for certain services. Implementing site-neutral payment reforms in the Medicare and commercial markets.
Telehealth flexibility. Permanently allows health savings account-qualifying high-deductible health plans to cover telehealth and remote care services on a pre-deductible or no-deductible basis without interfering with an individual’s eligibility to make or receive HSA contributions.
HSA enhancements. Allows individuals to convert their own health flexible spending account or health reimbursement account funds into an HSA, subject to annual limits. Allow HSA-eligible individuals to make or receive HAS contributions even if they are eligible for free or discounted employer onsite clinics, enrolled in Medicare Part A or their spouse has an existing FSA.

Some key bills are awaiting Congressional action, Manville said, including:

Patients Deserve Price Tags Act (HR 5582/S 2355). Would require public reporting of negotiated rates, costs and cash prices for services provided at hospitals, ambulatory surgery centers, imaging centers and clinical laboratories. Also would require providers and facilities to include an itemized bill of each distinct item or service, or an all-in-total price.
Healthy Competition for Better Care Act (HR 6248/ S 4027). Would promote affordability and health care transparency, and increase competition in the health care provider markets by restricting anti-competitive contract terms between payers, providers and hospitals such as “anti-steering” or “anti-tiering” provisions and “all-or-nothing” clauses.
Optimizing Participant Tax Incentives Through Optional Noncash Selections (OPTIONS) Act (HR 8314). Allows workers to direct non-cashable employer contributions to retirement plans, HSAs, HRAs and educational assistance programs.
Every Dollar Counts Act (HR 8270). Requires out-of-pocket expenditures for plan-covered drugs to count toward the plan participant’s deductible regardless of where the drugs were purchased.
PBM Fiduciary Accountability, Integrity and Reform (FAIR) Act (HR 6837/S 3549). Would apply Employee Retirement Income Security Act standards to PBMs performing services on behalf of employer plans.
Help Ensure Lower Patient (HELP) Copays Act (HR 6423/S 864). Would require copay assistance programs to be credited toward the annual deductible and out-of-pocket maximums.
Break Up Big Medicine Act (S 3822). Would prohibit common corporate ownership of a medical provider or management services organization and an insurance company or PBM.

Congress is considering future retirement policies, Manville said, with a focus on modernizing direct contribution plans.

The House and Senate had a set of hearings to examine a broad range of issues in laying groundwork for the next round of retirement policy reform, which would include:

Lowering plan eligibility age to 18
Encouraging adoption of automatic re-enrollment.
Allowing additional catch-up contributions for family caregivers.
Improving retirement savings for independent contractors.
Simplifying plan-to-plan rollovers.
Allowing workers to roll Roth IRA funds into employer-sponsored Roth accounts.
Encouraging broader adoption of lifetime income options.

Other retirement-policy legislation awaiting action in Congress include:

The Retirement Fairness for Charities and Educational Institutions Act would allow 403(b) investment in collective trusts.
The ERISA Litigation Reform Act would set a higher bar for ERISA-prohibited transaction lawsuits.
The Strengthening Benefit Plans Act would let DB sponsors use surplus assets to fund DC plan contributions and health care benefits.

Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at susan.rupe@innfeedback.com.