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Healthcare in the 116th Congress: What’s on the Horizon?

By Susan Walden, Managing Director, HillStaffer LLC

A long laundry-list of healthcare issues is on the agenda for a divided Congress and the Administration. As a result of the midterm elections the House is now controlled by Democrats, 235-199; in the Senate, Republicans retained control, 53-47. What’s being considered, and what are the prospects for action this year?

The two parties have significant differences in healthcare philosophies and legislative priorities so, as they enter the 2020 election cycle, they will be at odds on many issues, but compromise may be possible in some areas. Here’s a brief overview of some of the most significant federal issues that may have implications for your organization.

Prescription drug prices – Both Republicans and Democrats have expressed concern over the high cost of prescription drugs, including rising out-of-pocket costs and reduced access, as well as the lack of transparency in pricing. Pharmacy benefit managers (PBMs) and other middlemen in the supply chain are a main focus. Medicare Part D and Part B reforms may also be considered, including ways to give Medicare more leverage to negotiate. Changes in Medicare and Medicaid rebates are also under review. The U.S. Department of Health and Human Services (HHS) continues to implement its Blueprint to lower drug prices, and HHS Secretary Alex Azar recently proposed an International Price Index Model for Medicare Part B drugs. Congressional hearings are ongoing in both Chambers. Expect significant legislation here with potential bipartisan support for changes in some areas.

Affordable Care Act (ACA) health insurance plans – Democrats and some Republicans are interested in lowering health plan prices, providing more market stability, and ensuring that protections such as pre-existing conditions remain in place. Now that the House is controlled by Democrats there is no longer an opportunity for Republicans to “repeal and replace” the ACA. Some Democrats are embracing “Medicare for All” with the 2020 elections approaching, but Republicans support a more limited role for government and expanding private options rather than entitlement programs.

Other health insurance options – Look for more flexibility here. Association Health Plans (AHPs) and Short-Term Limited Duration (STLD) plans now have new life and can offer more choices due to recent Administration rules. Associations can have increased access to AHPs. STLD plans can be extended from three months to a year. Legislation expanding the use of Health Savings Accounts may be considered, as well.

Value-Based Care – Congress and HHS are focused on promoting value-based care and delivery system reforms that emphasize payment based on outcomes. The Center for Medicare and Medicaid Innovation (CMMI) continues to develop and test new models on value-based care, including bundled payments, direct provider care, and more options for emergency care. Congressional oversight of anti-fraud enforcement and potential changes to the Stark Law and the Anti-Kickback Statute are on the agenda, as well as HHS changes to the rules. Legislative reforms to improve value-based payments and coordinated care have been bipartisan in the past and should continue to have broad-based support.

Hospital payments and incentives – Congress has had ongoing interest in hospital payment incentives, including the 340B drug discount program, which has expanded greatly since its inception. Watch for congressional oversight and possible reforms.

Congressional investigations of providers – Congressional investigations into healthcare consolidation, anticompetitive concerns, nursing home safety and oversight, and nonprofit hospitals’ provision of charity care will keep providers busy and on their toes.

House Democrats will be motivated to act decisively before the 2020 elections and pass major legislation that contains their “messaging,” but those bills will not see action in the Senate. The Senate will pass bills which reflect Republican priorities and will be unlikely to advance in the House. Measures may develop traction and bipartisan support where there are common interests but, except for uncontroversial “must pass” bills, they will require significant compromise to be passed by both Houses and signed into law.

The outcome of healthcare issues in this divided Congress is uncertain, but many proposals are certain to garner attention and, ultimately, varying degrees of support. Are you prepared to react and, if necessary, to respond? If not, now is the time to create and implement a strategy to ensure that your organization’s interests are protected.