HealthCare Roundtable e-News – December 16, 2019

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BIG NEWS: Congress Includes Permanent Repeal of Health Care Taxes, Including ‘Cadillac Tax’ and Health Insurance Tax, in Year-End Package!

Yesterday, lawmakers released an end-of-year spending deal that permanently repeals both the 40 percent excise tax on high-cost plans, known as the “Cadillac tax, as well as the health insurance fee. The House is likely to vote on the agreements today (Dec. 17) with the Senate later this week. 

The Roundtable has long-supported full repeal of both taxes and has worked tirelessly with stakeholder allies to educate Congress on their impact. The Cadillac tax was set to go into effect in 2022 and the health insurance tax was set to be reinstated in 2020. The House voted overwhelmingly to repeal the Cadillac Tax earlier this year and the Senate bill to repeal the tax, which has 63 co-sponsors, had not yet been brought to the floor.  

The Roundtable will work with allies and bipartisan champions in Congress over the next several days to ensure the taxes are repealed and signed into law!

House Lawmakers Defer Surprise Billing, Drug Pricing & Extenders to May 2020, Include CREATES Act in Spending Deal

House lawmakers have pushed a vote on surprise billing and drug pricing legislation to next May as a result of year-end negotiations. However, the Roundtable-supported Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act will be included in a year-end spending deal. The legislation would make it easier for generic and biosimilar drugs to come to market when the brand-name drug is subject to a special FDA-mandated safety program known as REMS. The act would is projected to save almost $4 billion over the course of ten years. 

By deferring the vote on a broader drug pricing package to May, Medicare and Medicaid extenders will be limited to five months in the year-long government funding bill. House Speaker Nancy Pelosi (D-Calif.) sought the temporary extenders in order to create an opportunity to pass a legislative package that ends surprise bills and reduce drug costs prior to the 2020 election. 

Providers and lobbying groups are concerned that a continued delay will likely lead to dismissal of the bill from House Energy & Commerce and Senate health members, a win for most hospital and physician lobbying groups. Shawn Gremminger, Director of Federal Relations for patient advocacy group Families USA has said that, “any further delay helps providers’ positions, unfortunately. Worse, any delay makes it less likely it gets done at all.” (InsideHealthPolicy).

Year-End Spending Deal Reauthorizes PCORI for Ten Years

The year-end spending package agreed to by congressional leaders reauthorizes the Patient Centered Outcomes Research Institute for ten years, according to the final draft of the package released Dec. 16. The Roundtable is pleased to see PCORI reauthorized and is thankful for the efforts of Friends of PCORI and stakeholders across the spectrum who worked together to ensure its continuation.  

The package makes several changes to PCORI’s statute including: 1) Extension of the authorization to 2029 (i.e. 10 years more), 2) Increased mandatory appropriations to offset elimination of the transfers from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, 3) Consideration of the “full range of outcomes data” to include the “potential burdens and economic impacts of the utilization of medical treatments, items, and services on different stakeholders and decision-makers respectively. These potential burdens and economic impacts include medical out-of-pocket costs, including health plan benefit and formulary design, non-medical costs to the patient and family, including caregiving, effects on future costs of care, workplace productivity and absenteeism, and healthcare utilization.” 

The 12 appropriations bills will be sent to the House floor in two separate packages or “minibuses” starting tomorrow. PCORI reauthorization is in the second minibus to be considered, according to Friends of PCORI. After House passage, the minibuses will immediately go to the Senate for passage and then on to the White House for the President’s signature prior to midnight on Friday.

GOP Senators Ask Alexander to Change Approach to Air Ambulances in Surprise Billing Fix

Last week, Senate Commerce Committee chair Roger Wicker (R-Miss.) and several other Republican senators wrote to Senate Health Committee chair Lamar Alexander (R-Tenn.) to encourage the senator to change his committee’s surprise billing policy for air ambulances, which relies on a benchmark payment rate, to one based solely on arbitration. (Inside Health Policy). 

The Senators’ rationale is that the health committee’s current surprise billing fix for air ambulances could jeopardize access to emergency health care in rural areas and lead to base closures. In their letter, they wrote, “we encourage you to avoid any legislative language that would limit access to critical air ambulance services or create other unintended consequences.” 

The current compromise between committees on surprise billing sets a benchmark payment rate for out-of-network air ambulance bills for a geographic area and sets a threshold for going to arbitration at $25,000. The Senate Commerce Committee shares responsibility for air ambulances because the group has jurisdiction over the Federal Aviation Administration, and growing concerns over medical base closures are becoming a reality. Life Flight Network CEO Michael Griffiths said that the proposed legislation “has already had negative consequences” on his company and has had to place a hiring freeze on all non-operating positions as a result of the bill. (InsideHealthPolicy).