In 2019, the healthcare sector could see bipartisan pushes for greater healthcare price transparency, as well as policies aimed at controlling drug price increases, say policy advisers.


Nov. 9—A divided Congress may be a recipe for overall gridlock, but some healthcare policy watchers see hope for action in certain areas.

Among the biggest healthcare policy implications of the midterm elections, which gave control of the U.S. House of Representatives to Democrats and increased the Republican majority in the Senate, will be the suspension of efforts to repeal and replace the Affordable Care Act (ACA), said Jeanne Lambrew, PhD. Lambrew, a senior fellow at The Century Foundation and an adjunct professor at the NYU Wagner Graduate School of Public Service, was director of the Obama administration’s Office of Health Reform at the U.S. Department of Health and Human Services (HHS).

“But you will certainly see more and hear about protecting people with preexisting conditions, making prescription drugs affordable, [and] trying to get at the overall affordability issue,” Lambrew said on a media call. “Because a lot of dissatisfaction is driven by people who simply can’t afford their medicine or their health insurance.”

Despite the partisan divisions that continue over healthcare policy, both Lambrew and Lanhee Chen, PhD, a policy adviser to the 2016 presidential campaign of Sen. Marco Rubio (R-Fla.), expected action.

“Republicans on the Senate side are acutely aware that if they don’t address health care, what we’re left with is the aftermath of the 2017 repeal-and-replace debate, which was unsatisfactory from a variety of perspectives,” Chen said.

Potential actions include a “narrow set of agreements on market stabilization in the ACA or something around drug pricing,” Chen said.

“Republicans would be remiss to leave things as they are and not address them in some way or at least demonstrate to voters that they tried successfully to articulate an alternative,” Chen said.

Common Areas

Chen and Lambrew cautioned that the implications of policy agreement will depend on the details of the policies. Possible areas of healthcare policy agreement include a push for greater transparency.

As evidence of Democrats’ interest in transparency, Lambrew cited the Obama administration’s 2015 creation of a Medicare Drug Spending Dashboard, an online interactive tool presenting spending and use information on certain Medicare Part B and Part D drugs.

“Getting more information, more disclosure, and more education is relatively easy,” Lambrew said.

The Trump administration also has emphasized greater transparency, as seen in its recent rule that moves beyond requirements for hospitals to establish and make public a list of their standard charges—or at least to allow the public to request such a charge list—and instead requires hospitals to post those charges “via the Internet in a machine readable format and to update this information at least annually, or more often as appropriate.”

Among possible bipartisan actions to curb drug prices, Lambrew cited policies aimed at encouraging the use of generic drugs and fighting so-called pay-for-delay tactics by pharmaceutical firms. A related push was expected to change the Part D program “to align its incentives better to promote lower drug prices,” Lambrew said.

Lambrew said Democrats are watching to see whether Trump ends up agreeing with them on the need for Medicare to negotiate prices directly with drugmakers. The opioid crisis and extent of drug price increases in recent years may have increased the receptivity of Republicans to such an approach, she said.

Lambrew cited what she perceived as some movement toward that approach in a recent request by the Centers for Medicare & Medicaid Services (CMS) for public comments on a proposed plan to bring Medicare payments for most Part B drugs closer to the rates paid by other advanced countries.

 “How seriously we ought to take that or whether that would be something that would have an audience for a statutory change in Congress remains to be seen,” Chen said. “The appetite for that among Republicans is greater than at any point in recent history, which is not to say something is definitely going to happen.”

State Focus

Trump administration healthcare leaders have repeatedly emphasized the need for the federal government to allow more state flexibility in implementing a variety of healthcare policy experiments.  

Chen said efforts aimed at state innovation also will be the focus of future Republican efforts on healthcare reform. The push for greater state flexibility will be “the baseline off of which Republicans are going to operate over the next couple years.”

He foresees a scenario in which Senate Republicans coalesce around a set of reforms based on that theme, which they could implement in 2020 if Republicans retake bother chambers of Congress and hold the White House.

Executive Actions

Regardless of what elected officials at the federal and state levels decide on health care, Lambrew expected an increasing series of executive actions by the Trump administration. Those actions will include exercising its broad regulatory authority over Medicare, Medicaid, and individual-insurance markets, as well as decisions on legal strategy.

For example, the healthcare industry is bracing for potentially serious outcomes from Texas v. United States, in which 20 state attorneys general challenged whether the ACA remained constitutional after the end of the individual-mandate penalty. The Trump administration has declined to defend the ACA in that case.

The administration also is defending its creation of a recent rule to allow expanded use of short-term, limited-duration health insurance plans.

Lambrew expected Democrats to advance legislation from the House to roll back some the administration’s regulatory changes in health care. In October, the Senate narrowly defeated a rollback measure.

“Having been on the other side of this, accountability matters and makes the administration think twice, if not slow down, when it is thinking about executive actions that push the boundary,” Lambrew said.

Additionally, the House can file its own lawsuits, such as the Republican-led chamber did in the high-profile case House v. Burwell, which successfully challenged ACA cost-sharing payments to insurers.

Other areas of confrontation are likely to come over protections for those with preexisting conditions.

“To suggest the end of the recent hard-fought debate, where everybody seemed to walk out of the election saying, ‘Of course we care for people with preexisting conditions,’ may be premature,” Lambrew said.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Monday, November 12, 2018