Congressional Update – September 2021


House Ways & Means Unveils Legislation to Expand Medicare Benefits for Vision, Hearing, Dental Services

On Tuesday (Sept. 7), the House Ways & Means Committee released language spearheading the expansion of Medicare benefits, including coverage for major treatments and preventive services as part of the proposed $3.5 trillion budget resolution. The legislation would enable Medicare coverage of vision services starting in October 2022, hearing services in October 2023 and dental care in 2028.

“This is our historic opportunity to support working families and ensure our economy is stronger, more inclusive, and more resilient for generations to come,” said Committee Chair Rep. Richard Neal (D-Mass.) in a statement.

The proposed bill states that Medicare would pay 80% of the allowable costs for preventive, screening and basic treatments. For major treatments, though, Medicare would only pay for 10% of beneficiaries’ allowable costs in 2028, and that would grow 10 percentage points each year until the program pays for 50% of covered services starting in 2032. (InsideHealthPolicy)

The committee is planning to mark up the bill this week and will also take up a vote on a measure to ensure up to 12 weeks of universal paid family and medical leave for all U.S. workers, raise wages for child care workers, and provide funding for long-term care facilities to recruit new workers and retain them with added incentives such as wage subsidies and student loan replacement, among other reforms included in the draft package.

Employer Groups Struggling to Find Way to Leverage Medicare Drug Prices

As debate over drug price negotiation heats up in Congress, lobbyists for employers are keen to figure out how to provide Medicare drug prices to employer and union health plans. Drafting legislation for the Senate’s $3.5 trillion budget resolution is underway and while Democrats have said that they want employers and unions to get the appropriate prices for the insurance that they can offer, lobbyists and employer groups are expressing their concerns that lawmakers won’t be able to pull it off. Groups are hoping to make decisions by either making provisions that extend Medicare prices to the commercial market integral to Medicare negotiation and inflationary rebates or by binding those provisions to the tax code.

Senate Democrats have sought to include drug price negotiation into the package, though several upper chamber obstacles could lead to delays. One obstacle, known as the “Byrd rule,” restricts what could be included in the reconciliation package by requiring that provisions of the bill have a sufficient impact on the federal budget. Some experts say lowering drug prices for people with private insurance does not have as direct of an impact on the federal budget as lowering prices with Medicare; however, the Budget Control Act and Byrd Rule don’t provide definitions, so the Senate parliamentarian must make decisions based on precedent and legal language. (InsideHealthPolicy)

According to James Gelfand, senior vice president for health policy at employer group The ERISA Industry Committee, many employers would oppose the drug provisions in the bill unless the lower drug prices extend to the employer market. Gelfand said the group is exploring alternatives that could comply with the Byrd rule, including imposing an excise tax on drug companies that set prices in the employer market above the negotiated rate.

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