Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Health Care at the Second Presidential Debate

During the second presidential debate last week, Republican nominee Donald Trump and Democratic nominee Hillary Clinton went head to head on their policy proposals related to the Affordable Care Act (ACA). An undecided voter at the town-hall style debate asked how the candidates would improve the high costs and coverage of the 2010 health care law. Clinton expressed support for the law and outlined ways that it is protecting all Americans. She acknowledged the problems of rising premiums and health care costs, but stated the importance of improving the law, rather than repealing it, in order to expand coverage and lower the costs of premiums, deductibles and prescription drugs. Citing “astronomical” premium increases as a result of the ACA, Trump called for the repeal and replacement of the health care law, supporting the ability of insurance companies to sell plans across state lines. He claimed that people with pre-existing conditions would still be able to get health insurance coverage under his plan, and also called for turning Medicaid into a block grant program. 

Administration Continues Support for Cadillac Tax

The chief economist for the Council of Economic Advisers reiterated the case for the Cadillac tax on high cost health plans at an event hosted by the Mercatus Center last week. Matt Fiedler, one of President Obama’s top economists, stressed the importance of implementing the excise tax rather than repealing it permanently, especially without a replacement – which is what both candidates for president this year have promised to do. Fiedler did express support for making revisions to the tax, such as adjusting it for regions with higher health prices. The so-called Cadillac tax would impose a 40 percent tax on the most expensive insurance plans, and would provide a means for offsetting the cost of the Affordable Care Act (ACA). The tax would begin in 2018, two years after the initial start date, a result of the bipartisan congressional vote to delay the tax last year.

Brookings Releases Report on Surprise Billing

The Brookings Institution has released a new report that includes recommendations for lawmakers to solve the problem of surprise out of network bills. Such bills can occur in emergency situations, when patients do not have the capacity to check whether the emergency room or hospital they are brought to are in-network. Other times, patients are held liable for the cost of care provided by a single out-of-network provider, even if the patient did everything they could to ensure they remained in-network for a scheduled medical  procedure. The Institute calls for policymakers to take comprehensive action that targets surprise billing situations systematically to include at least all common hospital scenarios, rather than just emergency situations. They support federal action that either addresses patients covered by self-funded Employee Retirement and Income Security Act (ERISA) plans, or authorizes states to do so. Brookings also calls for improved transparency and notice to patients about out-of-network charges, as well as the enacting of  measures that hold patients financially harmless from additional costs associated with surprise non-network bills. The report encourages hospitals to increase network participation by key physician specialists. Finally, Brookings urges policymakers to select from among several regulatory and dispute-resolution approaches to fairly compensate nonparticipating providers, without distorting health plans’ and providers’ market negotiations.

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