With Congress focused on passing a 2024-2025 government spending bill, some bipartisan health care reform is likely to be delayed until later this year.
Those were the words of Jeff Manville, a partner at Mercer Law and Policy Group, who presented an update on the latest issues affecting health care in Washington during a recent webinar.
Issues that may see action during the lame-duck session of Congress include:
- Pharmacy benefit manager reform. Proposed reforms include requiring extensive disclosure of business practices to plan sponsors and the government; banning “spread pricing,” the 100% pass-through of kickbacks, fees and discounts to plan sponsors; and requiring PBMs and third-party administrators to disclose their direct and indirect compensation to plan fiduciaries.
- Employers report relief under the Affordable Care Act. Proposals include easing and extending the electronic delivery of Form 1095, expanding the use of date of birth instead of taxpayer identification number, allowing employers more time to address asserted employer joint liability concerns, and implementing a six-year statute of limitations for ESR assessments.
- Price transparency. Proposed reforms include codifying rules requiring disclosure of out-of-pocket costs and negotiated rates to plan participants and beneficiaries, ensuring plan sponsors have access to cost and quality data from vendors, and requiring government reporting on price transparency rules.
- The flexibility of telehealth. Proposals include treating stand-alone telehealth benefits as excepted benefits and permanently allowing high-deductible health plans with health savings accounts with no upfront deduction or credit.
- provider and hospital billing reform; It prohibits contract terms that discourage steering toward higher-value, lower-cost providers, requires hospital outpatient departments to provide a unique identifier on all billings, and prohibits hospital facility fees for certain services.
- Modernizing the HSA. HSA eligible individuals will be able to make and receive HSA contributions even if their spouse has an existing Health Flexible Spending Account, and individuals will be able to convert their FSA or Health Reimbursement Agreement into an HSA.
Manville said while a national paid leave policy continues to receive bipartisan interest in Congress, it’s unlikely that federal paid leave legislation will be passed in 2024.
The House task force recommended “coordination and harmonization” of paid leave requirements among states. The task force also recommended a public-private partnership pilot program for states to launch new paid leave programs and an association-style pooling plan for small business paid leave insurance.
Affordability of health care is a major issue in this year’s election campaign, but the tax treatment of employer-sponsored health insurance could become an issue as Congress prepares for the expiration of personal tax breaks as part of the 2017 Tax Cuts and Jobs Act, Manville said.
President Joe Biden’s health care priorities heading into the 2024 election include:
- Expanding Medicare Drug Cost Controls in Inflation Control Act.
- Strengthening price transparency requirements.
- Address provider consolidation and anti-competitive practices.
- Permanence of temporarily enhanced ACA subsidies.
Republican presidential nominee Donald Trump is expected to reiterate his previous health policy priorities, Manville said, including:
- Reduced drug costs.
- Greater price transparency.
- Expand non-ACA coverage options, such as association, short-term limited term, and fixed coverage plans.
- Expanding and strengthening the HSA.
Manville said conservative House Republicans’ policy priorities for fiscal 2025 include a renewed push to not specify a cap on employee tax exemptions, while previous Democratic budget proposals called for taxing employer-provided health benefits for high-income earners. Both parties are under pressure to find ways to offset the costs of extending the personal tax cuts before they expire in 2025, he said.
“Lawmakers are already looking for revenue to pay for the tax cut extension, and the tax benefit for employer-provided health care is a sizable part of the tax code, so it’s no surprise it continues to be a target,” he said.
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