Week in Washington: Transparency Executive Order Coming

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: Transparency Executive Order Coming     

The Wall Street Journal reported that President Trump will issue an executive order “compelling the disclosure of prices in health care” on Monday (June 24th) . The Executive Order would be a directive to Federal agencies to create regulations that will require insurers, doctors, hospitals, and other key health care industry entities to release negotiated and discount prices. Key things to note here:

  1. The Executive Order has no force of law. The nitty-gritty details will not emerge until the regulation(s) are released, which could take months (if not longer).
  2. Even when the regulations are released expect lawsuits on the matter. Consequently, it is likely that it will take several years, if not longer, before the rules would be enforced.

Surprise Billing

Possibly the issue that has the greatest level of bipartisan consensus at the moment is the topic of surprise billing. The most recent (and biggest) attempt at handling surprise medical bills was released this week by Sens. Alexander and Murray. The new bill’s main solution to surprise billing would be to outlaw surprise bills being sent directly to the patient and limit insurance payments to the provider to the “median in-network rate”. While the CBO score hasn’t been released, Alexander stated that the CBO score indicated that the policy would reduce commercial premiums by about half a percent. The bill would also limit surprise billing for air ambulances.  Committee voting is expected next week although the full Senate won’t pick it up until mid-July. 

While the Federal government is considering action, many states have changed their laws to protect consumers from surprise bills. Kaiser has an excellent tracker as to what states are up to what here. NAHP has a good deep dive on Colorado, Nevada, New Mexico, and Washington here.

Rebate Rule

Politico reported major disagreements within the Trump Administration between White House officials and Secretary Azar on the rebate rule. While Azar appears to be in favor of pushing forward the rule, key White House Officials (such as Joe Grogan head of the Domestic Policy Council) are against it due to the cost. Internal disputes often result in a slower rule release than expected as the parties work out the disagreements.

HRA Rule

If you are still hankering details on the HRA rule. Katie Keith has a great summary here.

Research You Can Use

  • Work Requirements
    • A study in the New England Journal of Medicine found that the six months of work requirements in Arkansas materially increased uninsured rates and potentially had negative impact on employment rates for those Medicaid eligible. Overall, the state’s uninsured rate increased from 10.5% to 14.5%. The researchers found that work requirements were the main driver of the increase.
  • Inertia
    • New research from Coleman Drake found that inertia does play a major role in health plan choice on the Exchange.
      • Preliminary results suggest that the mean household is willing to pay $77 per month to avoid the hassle of plan switching (conditional on being aware of plan characteristics) and $282 per month for continuity of care.”
  • 2020 Rates
    •  CHIRblog does a good deep dive in 2020 Rate Filings and gleaned what issuers are thinking so far for the individual market.
    • Maine announced a preliminary rate increase of 4.7%. Based on preliminary rates that have been submitted, Charles Gabba has calculated on an average weighted basis premiums will increase 2.9% in 2020.

Things to Keep an Eye out for

  • The Supreme Court will decide whether or not to take the appeal for the risk corridor case next week. As a reminder if SCOTUS does not take the case, issuers would not receive any of the unpaid risk corridor monies.


Previous editions: 

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

05/09/2019: Balanced Billing, New Regs & More

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