August 26, 2019

Congress is entering the last week of its recess, but lawmakers already have a loaded agenda for when they return—and some of their biggest priorities deal with health care. Daily Briefing's Ashley Fuoco Antonelli has rounded up the three biggest priorities for the upcoming session.

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1.  Tackling 'surprise' medical bills

So-called "surprise" medical bills have garnered a lot of attention over the past year, and congressional leaders have said the issue will be a key legislative priority after the recess. But it remains unclear exactly how lawmakers will address surprise bills.

Currently, there are two major proposals that have gained traction in the House and Senate. The Senate bill would establish benchmark payment rates for out-of-network services based on the median in-network rate in the geographical area where the care was provided. This benchmark payment rate would apply to out-of-network care provided by hospitals, physicians, and air ambulance companies. The measure also would prohibit providers from so-called "balance billing."

The House bill similarly would set a benchmark payment rate, but it offers a fallback plan for providers who feel the benchmark rate is too low: an arbitration "backstop" that would allow hospitals to request an arbiter step in to negotiate a new rate. The House bill restricts arbitration to cases in which the payment in question is more than $1,250, and the arbiter would be able to consider only the complexity and quality of care involved in the case at hand.

Kaiser Health News' Rachel Bluth explains that employers and insurance groups generally prefer the benchmark payment rate approach, while provider and hospital groups favor arbitration.  Senate Health, Education, Labor and Pensions (HELP) Committee leaders said they opted against including arbitration in the Senate bill because the Congressional Budget Office has estimated a simple benchmark rate would be "the most effective at lowering health care costs." However, health committee leaders in both the House and Senate have said they'd be open to finding a compromise on arbitration as they work to reconcile their respective bills.

2. Curbing increases in prescription drug prices

Lawmakers also are hoping to pass legislation aimed at curbing rising prescription drug prices, and the Washington Post's Paige Winfield Cunningham writes that "[i]t's do-or-die time" for the effort. According to Winfield Cunningham, "If lawmakers don't find a bipartisan way forward this fall, prospects for anything substantial happening will fade as the 2020 election ramps up."

Winfield Cunningham writes that "the clearest legislative route" for addressing prescription drug prices is the Senate Finance Committee's "bipartisan but nonetheless controversial bill," which would cap price increase rates for drugs covered by Medicare. However, many Republican lawmakers oppose the bill, meaning lawmakers might have to alter the measure to get it passed through the Senate. To gain some Republican votes, senators could add a provision that targets rebates paid to pharmacy benefit managers, Winfield Cunningham writes.

Meanwhile, Democratic leaders in the House are expected to soon introduce a bill that would allow Medicare to negotiate prices with drugmakers—a proposal that's long been touted by Democrats but opposed by Republicans. However, according to Winfield Cunningham, Senate Finance Committee Chair Chuck Grassley (R-Iowa), "has warned his fellow Republicans that they might have to swallow such actions if they don't support" his committee's bill.

As lawmakers near the end of their recess, "Senate Finance staff have initiated negotiations with their House counterparts on drug-pricing legislation," Inside Health Policy's John Wilkerson and Rachel Cohrs write. They note, "The plan is to pressure Senate Majority Leader Mitch McConnell (R-Ky.) to hold a vote" on the Senate bill "by first getting the House to pass similar legislation."

3. Funding the federal government (including HHS)

Lawmakers also will face the task of funding the federal government when they return, as the Sept. 30 deadline for passing fiscal year 2020 appropriations bills approaches. But while funding the government has proved difficult in recent years, lawmakers this year set themselves up for a relatively smooth process.

Earlier this month, Congress approved a two-year budget deal that raised the U.S. debt ceiling, set new federal spending levels, averted $125 billion in automatic spending cuts, and opened the door for negotiations on individual appropriations measures for fiscal year 2020, which begins Oct. 1. The budget deal raises spending levels by about $320 billion over the next two fiscal years when compared with current levels.

Lawmakers still must take up individual appropriations measures to fund the government, including HHS and other health care programs, under the agreement to avoid a government shutdown on Oct. 1. A spokesperson for Senate Appropriations Committee Chair Richard Shelby (R-Ala.) has said the budget deal's passage will allow the House and Senate to move to pass their own appropriations bills and formalize an agreement when they return from recess.

But a new "White House proposal to cut billions of dollars in foreign aid could imperil" the budget agreement, Politico's Marianne Levine reports. And while we can't be certain whether a government shutdown is looming, we do know government shutdowns can severely affect federal health care programs.

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