Week In Washington:Balanced Billing, New Regulations, and More

May 9, 2019


Surprise Medical Bills

The big legislative news this week was President Trump calling on Congress to produce a bill to reduce surprise medical bills. The issue has already led to several hearings and a bipartisan group working on the topic. While there is agreement that this is an issue worth solving, there remains vast disagreement on what the solution is. Senator Alexander is aiming to have a bill passed by July although odds remain long that a consensus solution will emerge by then.

Regulation Watch

  • AHPsThe Department of Labor announced that it would be releasing a new proposed Association Health Plan regulation to address concerns in the aftermath of a court ruling that suspended the creation of AHPs under the new regulation.
  • Drug Prices- HHS finalized a regulation that requires prescription drug TV ads to include their list price. The regulation could mean as of this summer, TV watchers will see the list price of drugs in advertising.
  • Poverty Definitions- The Trump Administration released a proposed regulation that if enacted would reduce the number of people classified as poor. The Federal Poverty Level is updated each year based on inflation trends. If the regulation is finalized, the Administration would reduce the trend factor (switching the trend factor to something called chained CPI). The slower growth would mean fewer people, over time, would be classified as being poor, and therefore lose eligibility for income based programs (such as Medicaid).

Research you can Use

  • Individual Market Record Rebates –Kaiser Family Foundation completed its analysis of the 2018 individual market. The research found that individual market profits hit a post-ACA record with individual market plans averaging a MLR of 70%. Furthermore, KFF expects individual market carriers to owe over $800 million in rebates this coming year. In total, individual, small and larger group insurers are expected to issue $1.4 billion in rebates.
  • Medicare v. Commercial Prices: New research from RAND on the differences between commercial prices and Medicare prices. RAND found that the case mix-adjusted hospital prices of private insurance were 241% of Medicare prices in 2017 (this is an increase from 2015). The research does provide analysis at a state and service level so the research is an excellent resource for those thinking about private v. Medicare rates.
  • Medicare Advantage: KFF also released research on people who switch between traditional Medicare and Medicare Advantage. On average, individuals who switched spent $1,253 dollars less than those that did not switch. This finding was true even when controlling for specific health additions (i.e., someone with diabetes who switched spent about a $1,000 less than someone with diabetes who did not switch).
  • Children’s Health Coverage Statistics – New research from SHADAC found for the first time since 2008 the uninsured rate for children increased. The increase in uninsured rates were driven by decreases in Medicaid and individual market coverage (which overcame increases in ESI coverage). You can read the findings (including at a state level) here.