POLICY BRIEFINGS

Lawmakers Expand Surprise Billing Probe


House and Senate lawmakers are requesting more information from physician-staffing companies and insurers regarding their billing policies and practices as a part of an ongoing investigation into surprise insurance gaps. The letters, which were sent to Envision Healthcare, TeamHealth, Anthem, Cigna, CVS Health, Health Care Service Corporation, Highmark, and UnitedHealth Group, were signed by House Energy and Commerce Committee leadership Frank Pallone (D-N.J.) and Greg Walden (R-Ore.), and Senate Health, Education, Labor, and Pensions (HELP) Committee leadership Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). The lawmakers request details about “why surprise billing occurs, the policies and practices that help protect individuals from surprise billing, and the current incentives behind the negotiations between providers and insurers.” They request a response from the companies by January 9.


Individual Mandate Struck Down by Federal Appeals Court


A federal appeals court has struck down the ACA’s individual mandate while skirting the question of the law’s overall constitutionality in a 2-1 ruling. The decision narrows a previous ruling from Texas District Judge Reed O’Connor declaring the entire law invalid because Congress eliminated the financial penalty for not having health insurance. The 5th Circuit Court of Appeals Texas v. Azar decision keeps the 2010 health care law in effect for the time being, while remanding the case back to the federal judge in Texas to determine how much of the rest of the ACA, if any, is also unconstitutional. The appeals court directed O’Connor “to employ a finer-toothed comb on remand the conduct a more searching inquiry into which provisions of the ACA Congress intended to be inseverable from the individual mandate.”


USMCA Passed by House, to be Considered by Senate in 2020


The U.S. House of Representatives passed legislation to implement the U.S.-Mexico-Canada Agreement (USMCA) last week with strong bipartisan support by a vote of 385-41. Democratic lawmakers reached a deal with the President on the updated North American Free Trade Agreement (NAFTA) earlier this month after months of intense negotiations. The deal removes a provision that would have guaranteed 10 years of data protection for biologic drugs. The Senate Finance Committee is expected to take up the pact on January 7, and the full chamber is expected to pass the measure sometime next year after the conclusion of the President’s impeachment trial. The USMCA legislation cannot be amended and only requires a simple majority to pass.


Lawmakers Question CMS Administrator’s Use of PR Consultants


Democratic House and Senate committee leaders have written to HHS Secretary Alex Azar to reiterate a previous request for information regarding Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma’s use of taxpayer funds for private public relations consultants. The lawmakers first asked for documents relevant to the administrator’s awarding of such private contracts in March. They argue that “these contracts appear to be a highly problematic use of federal funds,” and “call into question the Trump administration’s commitment to transparency, ethics, and responsible stewardship of taxpayer dollars.” If the administration fails to provide the requested information and documents by January 9, the letter states that the lawmakers may use alternative methods to obtain the information about the awarding of these contracts. The letter was signed by House Energy and Commerce Chairman Frank Pallone (D-N.J.), House Oversight and Reform Chairwoman Carolyn B. Maloney (D-N.Y.), Senate Finance Ranking Member Ron Wyden (D-Ore.) and Senate Health, Education, Labor, and Pensions (HELP) Ranking Member Patty Murray (D-Wash.).


SOTU Address Scheduled for Feb. 4


House Speaker Nancy Pelosi (D-Calif.) has invited President Trump to deliver his annual State of the Union address on February 4. The White House stated that the President has accepted the invitation. Pelosi’s letter was sent two days after the House of Representatives voted to impeach the President. Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Chuck Schumer (D-N.Y.) have not yet reached a deal on the parameters of a trial, and it remains unclear when the articles of impeachment will be sent to the Senate and whether the trial will have taken place by the February 4 date.


Grassley, Young Request Report on U.S. Organ Procurement


Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and committee member Todd Young (R-Ind.) have written to HHS Acting Inspector General Joanne Chiedi to request that she examine the adequacy of the organ procurement and transplantation system in the U.S. The lawmakers praise a recent executive order that would overhaul organ donations, but state that there is “no question that more can be done right now to improve a system that is mired by inefficiency, waste, and a serious lack of accountability.” CMS has proposed a regulation to improve the measures used to assess organ procurement organization (OPO) performance, while a proposed rule from HRSA would remove financial barriers to living organ donation. The senators ask for details about the extent of HHS oversight of OPOs and previous relevant information gathered by the Office of the Inspector General (OIG).



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