Week In Washington: Legislation Updates

April 4, 2019

Bills on the House: This week was healthcare week on the Hill as several pieces of legislature advanced out of committees. Politico reported that:

  • 6 ACA improvement bills passed the House Energy and Commerce Committee (E&C) to provide funding for outreach, state-based market improvements, reinsurance, money for navigators and more. The bills were passed generally with Democratic-only votes so are not expected to gain traction in the Senate
  • E&C also passed 6 drug pricing bills. The bills include provisions that would “penalize brand-name drug manufactures that withhold sample products from generic makers, band brand manufacturing from striking deals with generic companies to keep products off the market, and several other bills. These bills were passed with bipartisan support and have a better chance of making it into law.
  • Education and Labor Subcommittees are reviewing legislative language on ways to reduce surprise out-of-network billing practices.

Major Healthcare Legislation Status: Major healthcare initiatives appear to be delayed until after the 2020 election. President Trump announced that major repeal and replace legislative language would wait until after the election and aides of Speaker Pelosi seemed to demure progress on Medicare for All legislation until after the 2020 election.

Social Determinants Codes: An expanding trend is for insurers to pay to improve social determinants as a way improving health and decreasing costs. The American Medical Association and UnitedHealthcare developed billing codes for social determinants of health (nearly 2 dozen new ICD-10 codes) which could become industry standards. You can read more about it here.

Research You Can Use: New research analyzed the breadth of Medicare Advantage plan networks. The research suggests that the share of MA networks with broad networks increased from 2011 to 2015 and enrollment in MA plans with broad networks also increased over same time period. You can read about it in Health Affairs here.

State Watch:

  • Nebraska announced that it would not expand Medicaid at least until October of 2020 and would likely be including work requirements in its waiver application. As a reminder, Nebraska voters passed an initiative in 2018 to expand Medicaid.
  • Alaska announced it aims to fully transform its entire Medicaid funding into a block grant.

New Jersey is proposing to operate its own State-based Exchange rather than rely on HHS to operate its Individual Exchange.