Week in Washington: Major Legal Developments for ACA, Executive Orders, and Balanced Billing Bill

Week in Washington is brought to you by Michael Cohen, PhD. Tune in each week to read the latest on healthcare policy and get a glimpse of what’s on the horizon.

Week in Washington: Major Legal Developments for ACA, Executive Orders, and Balanced Billing Bill 

Editors’ Note:

This is the 100th edition of the Week in Washington, the weekly blog designed to highlight the most important health policy issues going on in Washington DC. Thank you all for reading and supporting. Here’s to 100 more!  

Texas v. US Update

A major update to the Texas v. US case. As a quick reminder Texas v. US is the case as to if the ACA is legal. A lower court struck down the entire ACA and the Trump Administration decided not to appeal the ruling. Consequently, about a dozen Democratic leaning states and the House of Representatives took it upon themselves to appeal the ruling (if nobody appeals the ruling then the ruling stands and the ACA is struck down). The 5th Circuit (who is currently hearing the case) questioned whether the entities appealing the case had standing. If the 5th Circuit rules that nobody has standing to appeal then effectively the 5th Circuit would rule that the lower court’s ruling would stand (i.e., the ACA is unconstitutional). It would also complicate the case being sent to the Supreme Court. All together the 5th Circuit’s questions have been taken as an ominous sign for the ACA by legal observers. The 5th Circuit will begin arguments on July 9th so expect more news in the coming weeks. You can read more here.

SCOTUS Takes Risk Corridor Case

The Supreme Court (SCOTUS) is taking up the risk corridor case. Issuers have an outstanding balance of about $12 billion. Several issuers sued the Federal government for the unpaid amounts. The case has slowly worked its way to the Supreme Court. Previously courts have ruled issuers were not owed the monies but the fact that SCOTUS is taking the case is signal that the court is at least considering siding with issuers. The case will be heard this fall and likely decided around June. In the event that courts side with issuers there be significant downward pressure on individual market premiums and massive MLR rebates. Charles Gabba has a good run down of which issuers have outstanding risk corridor balances here.

Transparency Executive Order

Also this week President Trump released an executive order (EO) on transparency. As a reminder an executive order has no force of law. It’s an order for agencies to create regulations (in other words there is a delay between an EO and when it has an impact). The EO has the following directives to the agencies:

  1. Within 90 days solicit feedback from the public on what requirements should be on providers, insurers, and the self-insured health plans in terms of releasing transparency and improving competition. There is some speculation that this could include questions about provider consolidation. There is no time table for an actual regulation to be released.
  2. Directs the Treasury Department to make it easier for consumers to purchase high deductible health plans with health savings accounts, for consumers to have more funds available for HSAs, and allow people to use HSA funds on health case sharing ministries and direct primary care arrangements.
  3. Directs HHS, Labor, and Treasury to increase the publics’ access to claims data for research and analysis.
  4. Directs HHS to align quality measures and reporting across Federal programs (e.g., Medicare, Medicaid, Exchanges, etc.)
  5. Release a report on ways to reduce surprise medical billing.

An excellent summary of the EO can be found here.

Hill Watch

  • The Senate Health committee passed its bill that tackles surprise medical billing. The bill includes a benchmark approach despite provider opposition. It is expected to be taken up by the full Senate later this month after the July 4th recess.
  • The Senate Finance committee is considering a proposal that would require drug companies to pay back rebates to Medicare Part D if prescription drug prices increase faster than inflation. Sens Grassley and Wyden are working on a bipartisan solution to prescription drug costs.  


Previous editions: 

06/21/2019: Transparency Executive Order Coming 

06/14/2019: Regulation Watch

06/07/2019: Block Grant Regulation Coming?

05/30/2019:  New and Notes of Note

05/23/2019:  Potential Healthcare Legislation Unveiled 

05/17/2019:  Surprise Billing-Proposed Laws

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