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.


House Panels Advance Additional Surprise Billing Proposals

The House Education and Labor Committee, which has jurisdiction over employer-sponsored health insurance plans, approved its surprise billing legislation, the Ban Surprise Billing Act (H.R. 5800), last week by a vote of 32-13 after hours of debate over whether the bill appropriately balances the interests of providers and payers. The House Ways and Means Committee also considered a bill (H.R. 5826) to protect patients against surprise insurance gaps last week, advancing the Consumer Protections Against Surprise Medical Bills Act by voice vote.

House lawmakers are now faced with the task of reconciling the differences between the three pieces of surprise billing legislation that have been advanced out of committee. Each of the bills would prohibit balance billing and hold patients harmless from surprise insurance gaps. The bills differ, however, in how payment disputes between providers and insurers would be resolved.

The House Energy and Commerce Committee and Education and Labor Committee proposals would set a benchmark payment for out-of-network charges based on the median amount for a service in a particular geographic area while providing for an arbitration process for bills above $750, or $25,000 for air ambulance services. The Ways and Means Committee proposal does not use a benchmark payment rate, instead relying solely on a mediation and independent dispute resolution (IDR) process. Unlike the other proposals, the plan would not ban surprise bills from air ambulance providers. During the markup, Ways and Means panel members argued that more data on the problem of air ambulance surprise bills needs to be collected first in order to avoid closure of air ambulance companies and a negative impact on rural communities. The White House has signaled opposition to the Ways and Means bill, raising concerns that too heavy a reliance on arbitration will increase health care costs. White House spokesperson Judd Deere also stated that the President does want air ambulances to be included in the final surprise billing plan.

During markup, Education and Labor’s Ban Surprise Billing Act was opposed by a bipartisan group of lawmakers who characterized the legislation as government rate-setting. They argued that the bill unfairly favors insurers, and expressed concerns about its potential to drive down prices for providers in their districts and negatively impact patient access to care, voicing support for the rival legislation introduced by the Ways and Means Committee.

The Congressional Budget Office (CBO) has released its cost estimates of the two bills passed out of committee last week. CBO estimates that the Ban Surprise Billing Act would save $23.8 billion over the next decade, a figure comparable to that of the measure passed by the House Energy and Commerce Committee. Ways and Means’ Consumer Protections Against Surprise Medical Bills Act would save $17.8 billion over 10 years.

A bipartisan group of House aides met with House Speaker Nancy Pelosi’s (D-Calif.) office last week to discuss a path forward for the rival bills, but no consensus was reached. Lawmakers hope to reach a deal on surprise billing before funding for a number of health care programs expires on May 22. The surprise billing legislation could be used as an offset for the must-pass package of Medicare and Medicaid extenders.

The Senate will return from Presidents’ Day recess on February 24, while the House of Representatives is scheduled to reconvene on February 25.

WH Releases Presidentís FY 2021 Budget Proposal

The Office of Management and Budget (OMB) transmitted the President’s proposed fiscal year (FY) 2021 budget to Congress last week. The $4.8 trillion “Budget for America’s Future” projects economic growth above three percent and would add $5.6 trillion to the deficit over the next decade. The administration requests $590 billion for nondefense discretionary programs, less than the cap for FY 2021 established in last year’s budget agreement. The budget calls for $96.4 billion in discretionary funding for the U.S. Department of Health and Human Services (HHS) – a nine percent decrease from current levels – as outlined in the HHS Budget in Brief.

The Centers for Disease Control and Prevention’s (CDC) budget would be reduced to $5.62 billion, a nine percent reduction. Funding for the National Institutes of Health (NIH) would be lowered to $38 billion, a 3.7 percent reduction. In line with previous Trump administration budget proposals, the budget would eliminate the Agency for Healthcare Research and Quality (AHRQ), merging it with the NIH as the National Institute for Research on Safety and Quality. The Food and Drug Administration (FDA) would receive a total of $6.2 billion - $3.3 billion in discretionary funds and $2.9 billion in user fees.

The budget proposes significant spending reductions for Medicare, Medicaid, and other mandatory programs. It includes a total of $920 billion in Medicaid cuts over the next decade, with $150 billion in cuts resulting from implementation of Medicaid work requirements and other savings achieved from changes such as tighter beneficiary eligibility screening and transitions to state block grant funding. The budget also calls for approximately $756 billion in savings from the Medicare program. This money would come from reducing program fraud and waste and through site-neutral payment policies, which the budget estimates could save $164 billion over the decade.

The budget includes $844 billion in spending cuts over 10 years stemming from the “President’s health reform vision,” the administration’s plan to repeal and replace the Affordable Care Act (ACA). While an exact proposal is not spelled out, the budget does call for ending additional funding to states that expanded their Medicaid programs under the 2010 health care law.

The budget also assumes a savings of $135 billion over the next decade from drug pricing legislation. While the budget does not endorse any specific legislation, this figure is similar to the cost estimate for the drug pricing bill advanced out of the Senate Finance Committee. The budget proposal also expresses support for capping Medicare beneficiaries’ annual drug costs and increasing generic and biosimilar competition. The budget proposal calls on Congress to end surprise medical billing, but it does not discuss a particular policy solution or set a savings target.

While Democrats on Capitol Hill quickly characterized the President’s budget as ‘dead on arrival,’ the document is a helpful starting point for understanding the administration’s priorities for the coming year.

February 18, 2020: | Page 1 Page 2 Page 3 Page 4



 -  2023

 +  2022

 +  2021

 +  2020

 +  2019

 +  2018