Mar 06, 2019
by Ken Doyle
I was honored to meet with legislators on Capitol Hill to advocate for brokers as part of the NAHU Capitol Conference. Samantha Siders, LISI Regional Sales Representative also attended. I am proud to say that she is president-elect of SAHU. It was very encouraging that our industry came together to educate legislators on the importance of maintaining consumer choice and the vital role that brokers play in creating a better health care system. This article recaps the conference sessions. The need for health care efficiency and transparency was a consistent conference theme. National health care expenditures are projected to grow 4.8 percent in 2019 to reach $3.8 trillion. As much as 20% of that spending is wasted. For example, patients get countless screenings that are unrelated to their illness or treatment, and providers often order bundled labs with unnecessary tests. Another big cost driver is hospital consolidation and acquisition of provider practices. Experts discussed several initiatives to address cost drivers and improve care.
More HSA and HRA Flexibility High deductible health plans have become increasingly popular with 40% of Americans now enrolled. But employers need more flexibility to set up account based plans, such as health reimbursement arrangements (HRAs) and health savings accounts (HSA). HHS Secretary, Alex Azar said that one of the most exciting options is using ACA tax credits to fund new, consumer-driven savings accounts that can pay for premiums or out-of-pocket costs. The Administration is exploring a proposal to expand the definition of preventive care under HSAs to cover more chronic disease prevention. A proposed rule would allow HRAs to reimburse employees for purchasing individual health insurance. Employers would get the same tax advantages for making HRA reimbursements for employees to purchase individual coverage as they now get for traditional employer-funded group coverage.
Surprise Billing Azar said that bringing price transparency to all health care markets is a top priority for this Administration. “The most high profile example of this challenge is surprise billing. “You could literally work for the insurance company who provides your coverage or have sold the plan you hold to thousands of customers, and yet you’re still none the wiser when a specialist who enters your hospital room isn’t covered by your plan,” he said. NAHU supports the following measures to combat balance billing:
- Prohibit health care providers from balance billing patients in cases of emergency, involuntary care, or when the patient has no choice in the provider.
- Require a notice that informs the patient of their providers’ network status and options for seeking care from a different provider.
- Set reimbursement criteria based on market rates determined by reasonable, contracted amounts paid by private health plans to similar providers in a geographic area or a percentage of Medicare.
Drug Cost Transparency Azar said, “Today’s drug market is non-competitive and non-transparent. With skyrocketing list prices, drug cost sharing is highly unpredictable… Last month, we proposed to replace the system of back door rebates in Medicare part D with a system of up-front discounts delivered at the pharmacy counter…We believe it may influence trends in the commercial space as well. Members of Congress can get to work on extending this proposal to the commercial market.” According to an HHS press release, “The proposal would also address the most significant incentive drug manufacturers cite in raising their list prices every year — the pressure to provide larger and larger rebates. This rule provides a clear pathway for drug companies instead to compete to have the lower price and out-of-pocket cost to the patient.”
Medicare for All Lauren Crawford Shaver, Executive Director of the Partnership for America’s Health Care Future explained why Medicare for All is choice for none. It means eliminating the private coverage that millions depend on, disrupting patient care, and forcing every American into a one-size-fits-all plan run by Washington, she said. A forthcoming House Medicare for All bill would eliminate employer-provided coverage. She warned that Medicare buy-in legislation represents a stepping stone to single payer. Two proposals would create a Medicare buy-in option for people who are not yet eligible for Medicare (Sen. Stabenow, S. 1742; Rep. Higgins, H.R. 3748). One proposal would create a Medicaid buy-in option that states can elect to offer to individuals through the ACA marketplace. (Sen Schatz, S. 2001 and Rep. Luján, H.R. 4129). Two independent studies reveal that Medicare for All would cost $32 trillion over 10 years. “The public does not support Medicare for All once they learn what it means,” she said. A recent Kaiser Family Foundation poll reveals that support for "Medicare-for-all" falls steeply when people are told that it could require most Americans to pay more in taxes or it could eliminate private insurance companies. “Working within the existing system, we can bring down costs and extend coverage to millions more Americans by expanding coverage at the state level through Medicaid, using tools such as reinsurance to stabilize premiums, and expanding federal subsidies so more people at all income levels can afford insurance,” she said. LISI’s Senior Vice President of Sales, Ken Doyle, serves on the NAHU General Agency Council advisory committee.
At LISI, we are continually tracking important legislative trends. To get an update on state and federal legislation, contact your LISI Regional Sales Manager.
