What Congress Can Do for Healthcare

 

Instead of taking an August recess, Congress could be taking steps to improve our healthcare. While it’s unlikely Congress can agree on anything, there are steps they could take before the election that would make a difference.

Brian Blase, writing in Forbes, says Congress should do the following to improve our healthcare:

  • Codify the Trump price transparency rules
  • Prohibit balance billing
  • Expand Health Savings Accounts (HSAs)
  • Provide states with greater Medicaid flexibility

 

Codify Price Transparency Rules

It’s really a no-brainer that patients should know the cost of what they are purchasing – before they receive their care. Polls show nearly 9 of 10 Americans agree. When patients know the cost of healthcare they become better shoppers, they lower the cost of their healthcare, and they force providers to compete not only on quality but also on price. This is good for patients and the overall cost and quality of the healthcare system.

The Trump administration has finalized a rule requiring hospitals to provide upfront prices for healthcare services. They are also requiring insurers to publish the amounts they reimburse providers for covered treatment. Blasé says, “Congress should lock in the Trump administration’s price transparency rules to end the legal battles over them and to give the American people the information they need to make smarter decisions about their health care and coverage.”

As a practicing orthopedic surgeon, I’m all for this price transparency. I want patients to know the actual cost of their treatment and I’m not afraid to discuss this in advance. But hospitals have traditionally balked at such proposals because they routinely vary their charges according to insurers and pre-determined contractual agreements.

Prohibit Balance Billing

Balance billing means billing patients more than the network cost-sharing amounts stipulated in their insurance contracts. The problem usually occurs when a patient goes to a hospital in their insurance network, but some of the providers working there are not in the network. The patient then gets billed more than their network coverage allows.

Congress should ban such balance billing so patients don’t receive surprise bills after they receive treatment at in-network hospitals or medical facilities. Providers who do not participate in the network should advise patients beforehand or accept the in-network reimbursement.

Expand HSAs

HSAs give patients more control over the spending of their healthcare dollars. These tax-deferred accounts incentivize patients to use these dollars wisely so they get the best value for their money. They have been shown to lower healthcare costs as much as 30 percent.

Currently, only people with a certain type of coverage – a plan with a high deductible that meets several requirements – can make HSA contributions. Congress should allow everyone, regardless of their insurance, to have an HSA. They should be able to continue contributions to these accounts even when they become eligible for Medicare, which currently disqualifies them. Recent legislation has been introduced by Texas Senator Ted Cruz and N.C. Rep. Ted Budd to allow anyone to contribute to an HSA during the extent of the coronavirus health emergency. This would be a useful first step.

Blase also believes Congress should consider contributing funds into HSAs for people with employer coverage who lost that coverage over the past few months due to the pandemic. He suggests Congress contribute $1500 to the HSAs of people with single coverage and $4000 to those with family coverage.

Provide States Greater Medicaid Flexibility

The Families First Coronavirus Response Act (FFCRA), signed into law this past March, provided a 6.2 percentage point increase in the federal reimbursement of state Medicaid expenses for traditional enrollment categories. This new law disproportionately benefits those states that expanded Medicaid under the ACA (ObamaCare). There is widespread evidence of fraudulent enrollment, especially in those states that expanded Medicaid.

The FFCRA actually prohibits states from taking steps to ensure only eligible enrollees are receiving benefits. This forces states to cover the costs of many ineligible enrollees, putting severe pressure on state budgets. Congress should undo the restrictions of FFCRA that prevent states from ensuring their Medicaid enrollees are actually eligible for benefits.

Two Steps Congress Should Avoid

These four steps Congress should take to improve healthcare. But there are two other steps they should avoid lest they contribute to worsening of our economic recovery from the pandemic.

In May, the House of Representatives passed legislation that fully subsidizes unemployed workers’ continued participation in their employers’ health plan through COBRA and expands ACA subsidies. The real beneficiaries of these funds are the health insurance companies. Blasé says the insurance companies are sitting on record profits because of the sharp drop in healthcare utilization by millions avoiding medical care due to the pandemic.

He says these subsidies also disincentivize workers to return to work leading to higher unemployment rates. Also, COBRA subsidies, in contrast to HSA expansion, locks recipients into using government aid only for COBRA premiums, which means they can’t be used in ways that would help these people more.

Avoid State Bailouts

Lastly, Congress should avoid bailing out states who have wasted taxpayers’ funds through poor governance. States that expanded Medicaid eligibility are a good example. If Congress feels compelled to provide aid to states and local governments, it should not be by raising the percentage that the federal government reimburses state Medicaid spending. Doing so would reward those states most wasteful and encourage states to further divert Medicaid money for other purposes.

Blase says potential reforms include: gradually lowering the ACA’s Medicaid expansion reimbursement rate until it reaches parity with the rate for traditional Medicaid recipients; requiring that Medicaid funds go for healthcare for the poor; permitting states to review Medicaid eligibility more frequently than yearly; requiring CMS to conduct annual eligibility audits of state Medicaid rolls and to make recoveries of improper state receipt of funds; and eliminating hospital presumptive eligibility.

All of the above makes good sense, but unfortunately our Congress is so divided that even common sense stands little chance of being considered. November will determine if we move forward with needed reforms to the current system or drive over the proverbial cliff and accept socialized medicine. Reform is better than suicide.

 

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