Framing the Week

With impeachment in the rearview mirror Congress returns to some sense of normalcy this week – perhaps with enough time to pass meaningful health care reform. Between the recesses and caucus retreats, the House and Senate have approximately 35 and 50 legislating days respectively to reach a deal on surprise medical billing and prescription drug pricing ahead of the May 22 deadline.


Today, President Trump is slated to release his budget proposal, laying out his spending priorities for fiscal year 2021. While the budget is expected to be immediately dismissed by House Democrats, it will likely guide Senate Republicans as they craft their own budget plan. The marathon of budget-related hearings begins this week, with Acting OMB Director Russell Vought before the House Budget Committee and HHS Secretary Alex Azar before the Senate Finance Committee.

The budget request is expected to allocate $96.4 billion in discretionary funding to HHS – a 9 percent topline cut to the 2020 enacted level. Regarding Medicaid, the President’s budget is expected to propose several changes aimed at reducing spending, including work requirements, as well as initiatives intended to address waste, fraud, and abuse, such as more stringent screening, enrollment, and termination. Medicare is also not safe from the chopping block, as the budget is expected to propose graduate medical education payment reforms, as well as site-neutral payments. The Trump administration’s budget proposal also leaves the door open to comprehensive drug pricing reform, anticipating savings of $135 billion across the decade – which is around the savings that the Congressional Budget Office initially estimated for the Grassley-Wyden bipartisan drug pricing package (S. 2543)

Whether the policy proposal to “advance the President’s health reform vision” in the President’s budget – projected to save $597 over 10 years – is a heath care plan designed to replace the Affordable Care Act (ACA) is not yet known. Including a replacement plan – especially one that protects people will preexisting conditions, as the President has repeatedly vowed to do – would help bolster his record on health care as he seeks reelection. However, the Supreme Court’s refusal to expedite consideration of an appeal of the Fifth Circuit’s decision in Texas v. United States bought the Trump administration more time to hammer out a strategy. Next Friday, the Court will discuss whether to take up the case this term, leaving the possibility that the fate of the ACA may be settled before the 2020 election and forcing the administration to show its cards.

Surprise Medical Billing

It is a big week for surprise medical billing legislation over on the House side. The Education and Labor (Ed & Labor) Committee and Ways and Means (W&M) Committee finally mark-up their own bills addressing surprise medical billing on Tuesday and Wednesday, respectively. As it has been along, the main issue to watch for is how the Committees propose to resolve payment disputes arising from surprise medical bills.

Ed & Labor has aligned the Ban Surprise Billing Act with the compromise brokered by House Energy and Commerce (E&C) Committee leaders Frank Pallone, Jr. (D-NJ) and Greg Walden (R-OR), and Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN). Specifically, Ed & Labor proposes a hybrid approach that establishes a benchmark payment based on the median in-network rate and allows arbitration for services when the median in-network rate exceeds $750.

With their Consumer Protections Against Surprise Medical Bills Act of 2020, W&M proposes allowing parties to use a 30-day open negotiation process, followed by a 30-day mediated dispute process (i.e., baseball style arbitration) with no minimum threshold, if negotiations are unsuccessful.

Notably, the Ed & Labor W&M proposals allow similar claims to be batched together and considered jointly as part of a single mediated dispute process if (1) the items and services are furnished by the same provider or facility; (2) payment is required by the same health plan; and (3) the items and services are related to the treatment of a single condition. Ed & Labor also requires that the items and services be furnished within the same 30-day period. Since the Pallone-Walden-Alexander deal was brokered, Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH) have been urging Chairman Alexander to include the flexibility allowing multiple services to resolved in a single mediated dispute.

As part of its solution to address surprise medical billing, W&M will also mark-up a bill that would require certain entities who invest in medical care providers to report returns to the Internal Revenue Service. W&M will also mark-up the Helping Our Senior Population in Comfort Environments (HOSPICE) Act, which would establish a hospice program survey and enforcement procedures under Medicare.

Women’s Health

Tomorrow, the Senate Judiciary Committee will convene a hearing to discuss banning late-term abortion, which appears to have been scheduled in response to President Trump’s call for legislation doing so. The Pain-Capable Unborn Child Protection Act (S. 160), introduced by Committee Chairman Lindsey Graham (R-SC) and would ban abortion 20 weeks after fertilization, will likely be at the center of the hearing. On the flip side, the House E&C Subcommittee on Health will hold a hearing to examine legislation aimed at protecting women’s access to reproductive health care.

Veteran’s Health

Also, this week, the House Veterans’ Affairs Committee will hold several subcommittee hearings on various issues, including health equity, data privacy and portability, and the Community Care Network. Lastly, the Senate Special Committee on Aging will explore the issue of home health care in rural communities.

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Alyssa Llamas has a diverse background in health policy and public health, with seven years of experience in government, research