HealthCare Roundtable e-News – April 1, 2020


Thank You!

I’d like to thank everyone who was able to participate in Friday’s webinar regarding recent Federal legislation in response to the COVID-19 Virus. I hope you found the presentation informative and useful. Several have asked for copies of the presentation, you can find it by clicking here.

As the Nation continues to deal with the threat of this global pandemic, we plan to continue to communicate via our weekly e-News and with targeted webinars. If you have specific questions or topics that you’d like us to address, please don’t hesitate to reach out.

Most importantly, we hope you, your families, and your colleagues, are staying safe and healthy!

All the best.

Tom Lussier



COVID-19 Crisis Hits Pause on Drug Pricing Action Until December

Conversations around drug pricing action have stalled in the midst of the COVID-19 pandemic, and legislation will likely have to wait until December’s lame-duck session. The government’s $2 trillion stimulus package is expected to push off a key deadline for drug pricing and surprise billing legislation, and November’s general election will likely impact the timing and conditions of the discussions that follow.

Initial talks on drug pricing were intended to couple the legislation with Medicare and Medicaid extenders, which were left out of the initial emergency funding bills for the COVID-19 crisis. Congress included extenders in the third stimulus bill, although those extenders will only run through November.

In a scenario where Trump wins re-election and Senate Republicans hold a majority, Democrats will likely want to push drug pricing legislation before the end of the year. In a scenario where the Democratic presidential candidate wins the election, Democrats will likely block legislation in a lame-duck session in order to make changes in the new Congress. (InsideHealthPolicy).

Third Coronavirus Stimulus Package Leaves Out Obamacare Reform Provisions

Last week, President Trump signed a third stimulus package to aid Americans and the economy through the coronavirus pandemic, hours after the House passed the package on Friday (Mar. 27). The package includes funding for hospitals and telehealth providers, unemployment benefits, loans to industries and drug shortage requirements, but does not make COVID-19 drugs free in Medicare Part D, which House Democrats had sought to include.

Additionally, the package does not include Affordable Care Act reforms that House Democrats had pushed for, which would have lifted barriers to coverage and stability in the marketplace. Among the requested provisions from insurers and industry groups were a two-month special enrollment period, expansions to the ACA’s tax credits beyond 400% of the federal poverty level, ended the administration’s short-term health plan rule and set up a temporary risk corridors program. (InsideHealthPolicy)

In response to questions about the high costs of some Obamacare plans, House Speaker Nancy Pelosi (D-Calif.) told reporters she had planned to introduce an ACA improvement plan, titled the Take Responsibility for Workers and Families Act (TRWFA), on the policy’s tenth anniversary, but indicated it was overtaken by the pandemic. TRWFA would expand the ACA’s tax credits by removing the 400% percent of federal poverty level (FPL) threshold and limit premium contribution to 8.5% of income for all enrollees, mirroring the provision in the ACA improvement bill and is supported by wide-ranging stakeholders. (InsideHealthPolicy)

Health and law expert Timothy Jost suggested that the bill should not be considered so much “ACA reform” as instead a way of bolstering the ACA during this stressful humanitarian crisis. Jost stated, “what is most important perhaps is that we have the framework of the ACA to build on…Never has it been so important as now on its tenth birthday.”

Insurers Ask House and Senate Leaders to Consider Additional Asks in Future COVID-19 Stimulus Bills

Following the passage of the “Phase 3” stimulus package to address the ongoing COVID-19 pandemic which largely focused on provider and consumer financial relief, health plans are asking congressional leaders to include measures to protect insurance markets in any follow-on “Phase 4” legislation.

In a letter to Senate and Congressional leadership on Wednesday (Mar. 25), the Association for Community Affiliated Plans (ACAP) President and CEO Meg Murray praised the CARES bill but was disappointed the bill did not include a provision that would have required states to have continuous Medicaid eligibility in order to get increased federal matching funds, for example. Murray warned that removing the provision would leave many otherwise eligible individuals uninsured and without access to critical health care services.

“We believe this is particularly important for consumers that have been deceived by the false promises of short-term, limited duration insurance and are quickly realizing the need for comprehensive coverage,” Murray said in the letter.

Alliance of Community Health Plans (ACHP) President and CEO Ceci Connolly agreed with Murray that there are some “very positive” elements in the CARES bill, but it still tilts toward larger corporations. The group shared concerns for individuals, families and small businesses, including those that are already requesting grace periods for premium payments. (InsideHealthPolicy)

Medicare Trust Fund Closer to Insolvency Amidst COVID-19 Crisis

Experts are predicting the Medicare Part A Trust Fund might soon become insolvent as soon as 2022 as payrolls go down and medical costs go up due to the COVID-19 pandemic. According to last year’s trustees report, the fund is set to become insolvent by 2026.

While some experts say the fund shouldn’t be a focus for lawmakers’ during the current crisis, many agree the pandemic will have a significant impact on its solvency overall. Marc Goldwein, senior vice president of policy at the Committee for a Responsible Federal Budget, said the crisis is likely to negatively impact the trust fund, particularly in the next decade or two. (InsideHealthPolicy)

“As soon as we solve this crisis, the next big challenge will be that Medicare could be a year away from insolvency,” Goldwein said, and that will be a big challenge for whoever is in office in 2021.

Tricia Neuman, executive director of the Kaiser Family Foundation’s program on Medicare policy, commented that it’s been known for some time that Congress will likely need to deal with the issue, as this isn’t the first time Medicare has come close to becoming insolvent. Neuman agreed that with so many people losing work, it’s probable that the insolvency date will be sooner. (InsideHealthPolicy)