2022 Year In Review

Who We Are

The Public Sector HealthCare Roundtable is a non-partisan, member-directed coalition that exists to give public sector health care purchasers and state and local health plan administrators a voice in the design, development, and implementation of national health care policies. The Roundtable does this by providing in-depth policy analysis and monitoring, education on issues relevant to public sector purchasers, and a forum to collectively engage with key decision-makers in Washington, D.C.

What We Believe

The members of the Public Sector HealthCare Roundtable have a long-term commitment to maintaining programs that enable public workers, retirees, and their families to obtain high-quality health coverage at a cost that is affordable and sustainable for the workers, their families, and their employers. It is our belief that national health care policies should advance innovative proposals to constrain costs, increase value, and improve quality and efficiency in the health care delivery system.

Our 2022 Activity and Accomplishments

Public Policy Accomplishments

Drug Pricing Reforms Included in the IRA –

In March 2022, the Roundtable sent a letter to Speaker Nancy Pelosi (D-CA) and Senate Majority Leader Chuck Schumer (D-NY) urging Congress to pass the drug pricing package proposed by the Senate Finance Committee in its draft Build Back Better package. Over the course of the year, the Roundtable successfully advocated for federal policy solutions to lower prescription drug prices in the United States, leading to the protection of public sector retiree drug coverage in the IRA.

In August 2022, the President signed the IRA into law which includes important provisions that impact Roundtable members:

 

Drug Pricing Negotiations – Requires the federal government to negotiate prices for some top-selling drugs covered under Medicare Part D. HHS would negotiate prices for up to 10 Part D drugs in 2026, 15 Part D drugs in 2027 and 2028, and 20 Part D drugs in 2029.

Drug Rebates – Requires drug manufacturers to pay a rebate if prices increase faster inflation for drugs used by Medicare beneficiaries. Manufacturers that do not pay the required rebates would face a financial penalty.

Medicare Part D Reform – Eliminates a 5 percent coinsurance for catastrophic coverage in Medicare Part D, adds a $2,000 cap on Part D out-of-pocket spending in 2025, and limits annual increases in Part D premiums for 2024-2030. This section includes language protecting Employer Group Waiver Plans (EGWPs) which the Roundtable has strongly advocated for.

ACA Subsidies – Extends the enhanced ACA premium tax credits provided under the American Rescue Plan for three years through 2025 to increase generosity for individuals will household incomes below 400 percent of the FPL and expand eligibility for taxpayers above 400 percent of the FPL.

Implementation and Enforcement of the No Surprises Act (NSA) –

On January 1, 2022, implementation of the No Surprises Act began. Ending surprise medical bills has been a longstanding priority for the Roundtable. The Roundtable successfully advocated for the passage of the NSA in 2020 and supports its implementation and enforcement to help lower health care costs.

 

– On December 12, 2022, the Roundtable and 58 other stakeholders sent a letter to the Secretaries of Health and Human Services (HHS), Labor, and the Treasury, urging the Departments to stand firm against efforts to strike down the NSA.

– The NSA protects individuals covered under group and individual health plans from receiving surprise medical bills for most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. The legislation establishes an independent dispute resolution (IDR) process to help resolve payment disputes between plans and providers.

– In August, the Departments of HHS, Labor, and the Treasury released “Requirements Related to Surprise Billing: Final Rules”. In light of lawsuits and public comment, the final rules provide additional guidance on what a certified IDR entity must consider when making a payment determination The Roundtable supports the development of future rulemaking to reinforce guardrails for the IDR to prevent overuse of the process.

Extension of Telehealth Flexibilities in Omnibus –

In the FY2023 government omnibus spending package, appropriators chose to extend many of the Public Health Emergency (PHE) telehealth flexibilities offered through Medicare and other federal programs through December 31, 2024. The Roundtable supports the extension of telehealth flexibilities to expand access to quality, affordable health care. The omnibus bill extends significant flexibilities in the delivery of telehealth services –

 

– For Medicare beneficiaries, it extends the waiver of the originating site requirement, enabling beneficiaries to receive telehealth services at home; delays the in-person requirement for mental health services furnished through telehealth; continues coverage of audio-only telehealth services; enables federally qualified health centers and rural health clinics to serve as originating or distant sites; and expands the types of practitioners eligible for telehealth.

– For the Acute Hospital Care at Home Program, the bill extends the flexibility of telehealth requirements so that the originating site includes home or temporary residence through 2024.

– It renews flexibility for employers or plans using High Deductible Health Plans (HDHP) with health savings accounts (HSA) to cover telehealth services before plan members’ deductibles are met through January 1, 2025.

Supporting Lower Costs through PBMs –

The Roundtable supports efforts to constrain health care cost growth and PBMs play an important role in maintaining affordable drug costs for Roundtable members active and retired populations. In May 2022, the Roundtable responded to Federal Trade Commission questions on the impact of PBMs by sharing how PBMs help Roundtable members negotiate with all the parties in the pharmacy supply chains. The Roundtable encouraged the FTC to examine anticompetitive practices of drug manufacturers to address high-cost drugs.

Protecting EGWPs –

In August 2022, the Roundtable responded to the Centers for Medicare & Medicaid Services’ request for information on ways to strengthen the Medicare Advantage program. The Roundtable’s response highlighted the important role of MA, particularly EGWP plans, in ensuring beneficiaries continue to have access to affordable health care benefits.

Strategies to Control Drug Costs –

In September, the Roundtable released its 4th annual report on specialty drug costs to shed light on how public sector health plans are addressing the issue and to identify solutions. The report “Assessing the Unsustainable Cost of Specialty Medications: A Survey of Public Sector Health Plans” includes information on the rising price of specialty medications for public sector plan sponsors, strategies Roundtable members deploy to control costs, and federal policy recommendations. Key policy recommendations include:

 

– Ensure the timely implementation of the drug negotiation provisions in the IRA

– Enable the FDA to fast-track biosimilar or generic alternative drugs

– Increase competition for brand biologics by reducing the market exclusivity period

– Increase transparency on prescription drug pricing

Advocacy Activity and Stakeholder Collaboration

Webinars. In 2022, the Roundtable hosted several webinars and discussions to educate its members on pressing health care issues facing public purchasers of all sizes.

Corporate Advisory Committee. In August 2022, the Roundtable convened the Corporate Advisory Committee to discuss the role of the Committee and Roundtable’s programming and policy agenda.

IRA Implementation. In September 2022, the Roundtable hosted a webinar on the IRA to provide an overview of the health care provisions of the IRA and inform Roundtable members how the bill might impact their services.

Bipartisan Congressional Engagement. Over the course of 2022, the Roundtable continued to engage congressional offices on a bicameral, bipartisan basis to advance the Roundtable’s policy priorities.

Member Education. Over the year, the Roundtable continued to keep its members and the policy community informed about key issues in health care policy that impact public sector employees, retirees, and their dependents through forums and in-depth policy analysis.

Events and Leadership Activities

Federal Policy and Advocacy Forum.

In July, the Roundtable held the 2022 Federal Policy and Advocacy Forum to discuss federal health care policy priorities of the Biden Administration and the 117th Congress, trends in employment-based health benefits, and advocating for policy reform. Roundtable members had the opportunity to hear from leading policy experts including:

 

Melanie Egorin, Assistant Secretary for Legislation, HHS

Corey Ensslin, Senior Health Policy Advisor, Senate HELP Committee

Jonathan Heafitz, Vice President of Federal Affairs, Pharmaceutical Care Management Association

 

18th Annual Conference.

In November 2022, the Roundtable hosted its 18th Annual National Conference in Alexandria, Virginia which included sessions on congressional and administrative policy priorities, the role of consumer voice, progress in value-based care, innovations in Medicare Advantage, and market and health policy trends for 2023. Roundtable members and guests gathered in-person and virtually to hear insights from health care reporters, policy experts, and industry leaders including:

 

John Barkett, Senior Policy Advisor for Health Care Delivery System Reform, White House Domestic Policy Council

Sam Stein, White House Editor, Politico and MSNBC contributor

Purva Rawal, Chief Strategy Officer, CMS Innovation Center

Frederick Isasi, Executive Director, Families USA

 

New National Institute for Public Employee Health Care Policy.

At the 18th Annual National Conference, the Roundtable announced the formation of the Institute for Public Employee Health Care Policy, a nonpartisan, policy institute focused on public policy areas impacting healthcare plans available to public sector employees, retirees, and their beneficiaries.

For more information about Public Sector HealthCare Roundtable policy priorities and activities, please visit:

www.healthcareroundtable.org