Hospitals seek reversals of Trump policies, among various requests of Biden

Hospital advocates recently urged the incoming Biden administration to reverse the looming price transparency requirement among a range of other Trump administration policies.

Among the requests the American Hospital Association (AHA) sent in a letter to the incoming administration was that it rescind requirements for hospitals to publicly disclose negotiated rates starting Jan. 1.

The AHA said the requirements “do nothing to help patients understand their costs, could result in anticompetitive actions on the part of health plans, and, according to the Federal Trade Commission, could result in high costs for patients.”

The Federation of American Hospitals (FAH) wrote a Dec. 22 letter to Biden likewise urging the incoming administration to not enforce the price transparency requirements “while evaluating whether to rescind the onerous and anticompetitive requirement to publish hospital and commercial health insurer negotiated rates.” FAH said a revised transparency rule should drop requirements to disclose negotiated rates “while identifying opportunities to improve consumers’ access to clear, accurate, and actionable cost-sharing information.”

The hospital groups’ requests to the Biden administration were dominated by pleas to eliminate or reverse numerous other Trump administration policies, including:

• Site-neutral payment policies
• 340B discount drug program cuts
• The “public charge” rule that limits permanent status for immigrants in public health insurance programs
• Guidance for Section 1332 state waivers that hospitals worried would reduce insurance coverage or affordability
• Rules that expanded access to non-ACA-compliant plans, such as association health plans and short-term health insurance plans
• Recent rules that weaken maintenance-of-effort protections for Medicaid enrollees

Hospitals also want assurance that the Medicaid Fiscal Accountability Regulation (MFAR) proposed rule will not be returned to the regulatory agenda. MFAR would have limited common state Medicaid financing arrangements such as provider taxes, intergovernmental transfers and donations. It was formally withdrawn from the regulatory agenda by the Trump Administration, but the financial implications of the proposal are deeply concerning to hospitals.

“The FAH firmly opposes MFAR and urges the new administration to refrain from pursuing any similar regulation, the effect of which would impede access to Medicaid services, and threaten the fiscal health of states and many health care providers,” the advocacy group for 1,000 for-profit hospitals wrote.

New actions sought

The hospital groups also are seeking Biden administration action in areas where the Trump administration had declined to act.

For instance, FAH urged the incoming administration to work with Congress to incentivize state expansion of Medicaid programs.

Thirteen states have not yet expanded Medicaid eligibility as authorized by the Affordable Care Act (ACA). Since the strongest financial incentives to get states to expand eligibility have expired, FAH urged the incoming administration to push for enactment of a measure like the Incentivizing Medicaid Expansion Act, which would provide states with a 100% Federal Medical Assistance Percentage for the first three years of an expanded Medicaid program.

Other recommended new initiatives included:

• Bolstering outreach and enrollment efforts to increase signups in the ACA marketplaces
• Providing a special enrollment period for the ACA marketplaces for the duration of the public health emergency (PHE)
• Allowing states to delay Medicaid eligibility recertification during the PHE

Seeking pandemic response assistance

Hospitals also sought several initiatives as part of the continuing federal response to the COVID-19 pandemic.

For instance, AHA sought a federal communications campaign to emphasize vaccine safety “particularly among segments of the population who justifiably mistrust such efforts and [to] ensure tracking to understand better long-term outcomes and effectiveness.”

Although legislation signed into law Dec. 27 included $3 billion for the Provider Relief Fund (PRF), FAH urged the incoming administration to support adding “substantially more funding” to help hospitals and other providers respond to the pandemic.

“Further, given the unique challenges hospitals face, including large capital costs, escalating labor costs, and financial losses from a reduction in non-emergent clinical care, a significant percentage of PRF distributions should be directed to hospitals,” FAH wrote.