Proposal, Final Rule and Other Initiatives Aim to Reshape Medicare and Affordable Care Act
Summer is often a time in Washington where the business of government seems to slow down as everyone starts to look forward to the August recess and dreads the oncoming heat and humidity. However, this year is a change from years past, as not only has Washington pretty much been spared oppressive temperatures, but the Senate has decided to stick around most of August and the Trump Administration has issued a proposal, and a final regulation, that could very well shape healthcare policy for years to come.
Shortly before the House of Representatives left Washington for their districts, the Department of Health and Human Services (HHS) released the annual physician fee schedule proposal. The fee schedule establishes payment for physicians and medical professionals treating Medicare patients. It is updated annually to make changes to payment policies, payment rates and quality-related provisions. For 2019, it looks like HHS will pay approximately $750 million for chiropractic claims. However, while the fee schedule is a big part of the HHS proposal, the annual rollout also serves as an opportunity for the agency to serve up more than several policy changes.
For example, the proposal contains changes that HHS claims will increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. According to the agency, the proposed rule would “fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information, instead of information that is only for billing purposes.” One way HHS hopes to change this is by encouraging information sharing among healthcare providers electronically, so patients can see various medical professionals according to their needs while knowing that their updated medical records will follow them through the healthcare system.
Of course, patient access to chiropractic services is very limited and ACA is working to change that. ACA staff and volunteer leaders are still combing through the 1400+ page proposal and will comment on areas pertinent to the profession. ACA will release those comments in mid-September, when they are due to HHS.
Around the same time the proposed rule was released, the House passed a series of relevant bills that would affect Health Savings Accounts (HSAs). HSAs are a popular way for many consumers to pay for health care services, such as chiropractic, and under one of two measures passed by the House, taxpayers with a health savings account could use them to pay up to $500 for certain services before meeting their deductible, such as for primary care visits or telehealth services.
The bill would also repeal a provision of the Affordable Care Act that prohibits using all tax-favored accounts to purchase over-the-counter medicines. The measure would also designate gym memberships or other expenses related to physical activity, such as safety equipment, as a qualified medical expense.
The second HSA-related measure passed by the House aims to expand who is eligible to set up an HSA. It would allow working seniors who are enrolled in Medicare Part A but also have a high deductible health plan that qualifies for an HSA to set one up. It would also nearly double how much an individual or a family can contribute annually to an HSA. The Senate hasn’t indicated any plans to vote on an expansion of health savings accounts this year, in fact many observers believe action in that chamber this year is doubtful, at best.
Alternative Types of Coverage
Another more recent, and albeit more controversial, ruling to come down from the Administration is the one that establishes alternative types of coverage to that currently offered under the Affordable Care Act. On Aug. 1, HHS finalized a regulation that would let consumers maintain a short-term health insurance plan that skirts federal rules for just under a year, a step proponents claim will provide more affordable insurance options to more Americans.
The rule is part of the Administration’s effort to allow people to purchase healthcare plans that don’t need to comply with all regulations set by the 2010 Affordable Care Act and are typically less expensive than plans sold in the individual market exchanges.
The new rule will take effect in 60 days, although HHS officials claim it may only apply to plans being sold sometime next year. The rule reverses an Obama-era change that shortened the length of time someone could maintain a short-term plan to just under three months. Under the final rule, consumers could soon purchase short-term plans that cover an initial period of just under 12 months. A consumer could renew that plan for up to 36 months, based on the contract with the insurance provider, meaning the contract would indicate whether a consumer would provide medical information and go through underwriting again when renewing a plan. Also, plan providers must disclose to patients when explaining that the plans do not meet the requirements of the health care law. In that notice, insurers would need to note that the plans are not considered qualified health plans and that they may have lifetime or annual dollar limits on health benefits and may or may not be renewable.
Short-term limited-duration plans, which have historically been meant for people who are between jobs or other types of coverage, do not have to cover the healthcare law’s 10 essential health benefits, which are required types of services such as maternity or mental health care. They are also allowed to charge more or deny coverage if a patient has a pre-existing condition. Additionally, the plans don’t have to comply with the health law’s standards requiring plans to spend at least 80 percent of premium dollars on medical costs instead of components like administrative costs and profits.
Association Health Plans
This final rule comes a few weeks after the HHS and Labor departments finalized another rule meant to expand association health plans, which allow businesses to band together to buy insurance. Consumer advocates and many health-related associations like ACA are concerned that the association plans also could undermine the health insurance system.
Medicare for All
Finally, in late July, the price tag for a progressive health policy titled “Medicare for All,” was estimated to cost $32 trillion over 10 years in a study conducted by an outside independent source. “Medicare for All” is simply just that: a national health policy program where the federal government would become the purchaser, and distributor, of health care services. It’s also many times called the “single-payor” system.
The Medicare for All concept has been around for many years. However, it wasn’t until 2016 that the idea began to pick up steam, as Democratic candidate for president, Sen. Bernie Sanders (Vt.) made it a campaign issue. Sen. Sanders continues to support the concept today, and with the uncertainty surrounding rates on plans developed under the Affordable Care Act, from time to time, this proposal gets fresh legs, and more populist support. Sanders’ latest effort has 16 cosponsors in the Senate; however, it’s a certainty that the bill will not be brought to the floor for consideration before the session ends in December.
John Falardeau is ACA senior vice president of public policy and advocacy. Keep up with news from Washington by following Falardeau on Twitter @ACAontheHill.