DCMedical News: Thursday, July 18, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, July 18, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Axe the Cadillac Tax
The House voted 419-6 to repeal the Cadillac tax, a 40 percent excise tax on high-cost employer-provided health insurance, once envisioned as an important means to pay for health insurance expansion under the Patient Protection and Affordable Care Act (PPACA). The tax was set to go into effect in 2022, and may be safe for the moment, as Finance Committee Chairman Grassley says he does not see action on the measure taking place in the Senate this year. The Congressional Budget Office report on H.R.748 (the repeal bill, aka the “Middle Class Health Benefits Tax Repeal Act of 2019,”) is here. The Cadillac tax represented one of a large number of health economist theories embedded in PPACA, many evidence-free, some promoted through arguments their proponents subsequently admitted were lies.
A More Appealing Surprise
Additional appeal rights were added in the House to H.R. 3630, the “No Surprises Act.” The bill (see memo from Energy and Commerce Committee Chair Pallone, here) “Would prohibit balance billing and limit patient cost sharing to the in-network amount for emergency services. Additionally, the legislation would prohibit surprise medical bills from facility-based providers that patients cannot reasonably choose, whether arising from emergency care or scheduled care.” Resolution of out-of-network payment disputes between providers and insurers would require that the insurer pay, at minimum, the median contracted rate (in-network rate) for the services in the geographic area where the services were delivered.
By voice vote the Committee adopted an amendment which would (according to CQHealth) let “providers appeal for an independent dispute resolution process for claims over $1,250 in certain cases when a provider says a median in-network rate doesn’t cover its costs. A baseball-style arbiter would weigh proposals by the provider and the insurer before choosing one. The losing side would have to pay for related administrative costs.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Private Equity Firms May Find Themselves Filing False Claims, Committing Malpractice
Private equity is flowing to physician practices (here) and to health care generally (here)—Sutton’s Law at work. But a New York Court has decided (here) that private equity firms supplying “MSO” type services to captive physician practices may be exercising too much control over the professionals.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Inslee Care, Continued
Washington Governor Jay Inslee has signed legislation (effective January 1, 2020, report from American Health Lawyers Association blog here) which would require health care providers to give 60 days’ advance notice to that state’s Attorney General before closing any transaction involving two or more hospitals, hospital systems or provider organizations representing seven or more health care providers “The law can also apply to transactions with non-Washington parties if the out-of-state party generates $10 million or more in revenue from Washington patients.”
Immigration and Health Insurance
The Kaiser Family Foundation reports on the health insurance status of immigrants, here. Uninsured rate (for health care): citizens, 8%; legally present immigrants, 23%; undocumented immigrants, 45%.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
IRS Guidance Will Help Chronic Disease Patients Also Afflicted with High Deductible Health Plans
The IRS announced that it was revising Health Savings Account regulations, to implement a portion of the President’s June 24 Executive Order on Prices, Quality and Transparency in American Health Care, here. Modern Healthcare reports that the new IRS guidance, issued Wednesday, here, says “patients with certain chronic conditions face cost barriers that prevent them from seeking necessary care. Failing to address those needs often leads to consequences such as heart attacks and strokes that require even more medical care. The IRS, with the Treasury Department and HHS, re-classified certain medical services to treat chronic care as preventive for someone with that chronic condition. The list of 13 services that can now be covered without a deductible include insulin and glucometers for diabetes, inhalers for asthma, blood pressure monitors for hypertension, and SSRIs for depression.” The report added, “In 2017 about 19% of workers with job-based health insurance were enrolled in high-deductible health plans eligible for a health savings account, according to the latest data from the Centers for Disease Control and Prevention. That was up from 4.2% in 2007.”
DRUGS AND DEVICES
CVS and Dialysis, Technology Engine Behind New Kidney Dialysis Policy
CVS has invested in new home hemodialysis technology (here), a possible factor behind the administration’s major change in dialysis policy and kidney care generally (see DCMN of 7-11, and new policy here). Seeking Alpha reports, however, that CVS may face the usual obstacles in American medicine, not technology, but competing commercial interests: UBS says “CVS Health's potential entry into home dialysis may have limited success since patients will still need to work with a nephrologist and must belong to a clinic, requirements that CVS may struggle to match through its pharmacy network. UBS adds that CVS may also have difficulty extricating itself from non-compete contracts and joint ventures with established dialysis providers.”
READINGS AND REFERENCES
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm.
Committees and Members at https://www.senate.gov/committees/membership_assignments.htm.
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July publication dates: 23, 24, 25, 26
August publications dates: None
September publication dates: 9, 10, 11, 12, 17, 18, 19, 20, 23, 24, 25, 26, 27
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.