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By Michael L. Evans and Kevin Fleming
In this Gallup poll from late 2018—and in almost every other national research poll on the concerns of American voters—healthcare ranks as the No. 1 issue. Of course, healthcare is a complex, multifaceted issue, and voter concerns include the cost, quality, and availability of care as well as the availability of insurance and coverage of pre-existing conditions. The issue was recently given even higher visibility by President Trump’s executive order of June 24 mandating improved pricing disclosure in healthcare.
This heightened interest has been spawned in large part by the fact that, for more and more Americans, healthcare has become increasingly inaccessible. This compromised accessibility is largely attributable to high costs that even the insured, many now in high deductible health plans (HDHPs), struggle to afford. Whether or not one subscribes to the notion that healthcare should be a right, this issue is at the top of voters’ minds and on the agendas of the policy-makers who represent them. The objective: a U.S. healthcare system that brings care within financial reach for all Americans.
Whether or not additional regulations are really the best solution to the healthcare issues concerning Americans, it’s evident that more regulations are on their way. For industry innovators who lean in to these changes, we believe the prospects for longer-term success are promising, even groundbreaking. The challenge is finding the right partners and technology to make the necessary adaptations quickly and without undue disruption.
Currently, there are over 700 bills in Congress that reference health or healthcare. Few will receive the bipartisan support necessary to move them through Congress, and it’s likely that fewer will be signed into law by the president. Any way you look at it, the intense national spotlight on an issue that affects every American family is likely to yield some significant change.
The following are five key healthcare issues pending in Congress:
1. Patient engagement and disclosure
Many proposed bills (and the above mentioned executive order) focus on the disclosure of cost and financial information to the patient as well as the relationship between the patient, provider, and insurer—details which up to now have not always been transparent.
Cost disclosure has received a lot of focus from both the legislative and executive branches. The fact that patients do not receive information about costs up front impairs their ability to compare providers and the costs of alternative treatments. The executive order focuses on lowering healthcare costs via a variety of Department of Health and Human Services (HHS) initiatives designed to “enhance the ability of patients to choose the healthcare that is best for them.”
Legislation in Congress is focused on “surprise” medical bills. These are medical bills in which a patient unexpectedly finds one or more of their medical service providers is out-of-network and is therefore not covered or only partially covered, resulting in extraordinarily high costs.
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This bill would take the patient out of the negotiation between the provider and the insurer. Proposed by Senators Cassidy (R-LA) and Hassan (D-NH), the bill is fairly comprehensive in terms of addressing the surprise medical bills issue. One potential stumbling block is the provision that this bill would set payment rates for non-network providers, and it appears to face some opposition from the American Medical Association.
The House “No Surprises Act” version of the Senate bill, sponsored by Representatives Pallone (D-NJ) and Walden (R-OR), is similar to the Cassidy/Hassan bill but has fewer protections for the consumer and thus will perhaps face less opposition by the medical industry.
Neither of these bills addresses the adequacy of the insurance network system or level of care provided by out-of-network providers.
2. Drug pricing
A bill in the House of Representatives, sponsored by Representatives Alexander (R-TN) and Murray (D-WA), focuses on drug pricing and price transparency. This bill will attempt to address rapid and significant drug price increases which have occurred in the last few years, with drug companies often raising prices significantly, especially when the drug is unavailable from other drug companies. Also of concern is the practice of drug companies paying generic drug makers to keep generic versions off the market so prices can remain high.
Further along is Senate Bill 340, sponsored by Senator Leahy (D-VT), which would promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and similar versions of those products into the market.
3. Health insurance coverage
This bill is entitled the Marketing and Outreach Restoration to Empower Health Education Act of 2019 (or the MORE Health Education Act) and is sponsored by Representative Rochester (D-DE).
This bill requires the Department of Health and Human Services (HHS) to conduct outreach and educational activities regarding federally facilitated exchanges (i.e., health insurance exchanges that are established and operated within states by HHS). The activities must inform potential enrollees of the availability of coverage and related financial assistance under the exchanges, and this information must be provided in culturally and linguistically appropriate formats.
4. Pre-existing conditions
A bill directed at preserving the pre-existing condition provisions of the Affordable Care Act (ACA) is H.R 986 Protecting Americans with Preexisting Conditions Act of 2019. This bill nullifies the Department of the Treasury and the Department of Health and Human Services guidance titled “State Relief and Empowerment Waivers,” published on October 24, 2018. The guidance pertains to waivers (also known as State Innovation Waivers or State Relief and Empowerment Waivers), which allow states to forgo certain requirements of the ACA in order to implement experimental plans for healthcare coverage, as long as the resulting coverage meets certain statutory criteria. In essence, this bill preserves the pre-existing condition coverage of the ACA.
5. Medicare for all
Several proposals in the House are focused on extending Medicare to all Americans. This issue has become a focal point among Democratic presidential candidates for the 2020 presidential election. The bill, introduced by Representative DeLauro (D-CT), would amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans. Clearly lacking bipartisan support, this bill has a low chance of passing and is likely “dead on arrival” in the Senate.
With over 700 bills introduced in the Senate and House related to health and healthcare, it is difficult to predict how many and which particular bills will make it through the Democrat-dominated House and the Republican-dominated Senate to be forwarded to the president.
Without question, voter concerns and subsequent proposed legislation point toward the necessary evolution of the American healthcare industry. The industry that emerges from this period will face the same market pressures affecting nearly all sectors of the economy. But, as with other economic sectors, the providers that deliver what their customers perceive to be superior experiences and value will prevail.
Michael Evans is the Managing Director of Newport, LLC. Kevin Fleming is the CEO of Loyale Healthcare, LLC.
July 7, 2019 at 01:46PM
Forbes – Entrepreneurs