|Newly released Senate legislation to curb surprise medical bills would allow third parties to settle billing disputes, a provision that could complicate passage because it is opposed by the White House and absent from a House draft. The Senate bill represents nearly a year of work led by Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH). The Senate bill would have insurers pay out-of-network doctors and hospitals for the difference between a patient’s in-network cost-sharing requirements and the median in-network rate for their services. If either party wanted to appeal the amount, they could do so using an arbitration process. [AEI’s Jim Capretta explains at RealClearPolicy why arbitration is not a good idea.]|
Bipartisan legislation unveiled this week in the House would limit hospitals and doctors to charging health insurers local market prices for care that is outside a patient’s network, a measure intended to curb surprise medical bills. At a news conference last week, President Trump emphasized bipartisan support for a fix. The House Energy and Commerce Committee unveiled its “No Surprises Act” that would require patients be told which providers are out of their network and whether they could face additional charges. Lawmakers will be collecting feedback in the coming weeks to refine the bill.
|On Wednesday, the Congressional Budget Office released a 30-page report analyzing a single-payer health insurance plan. While the publication explained some policy considerations behind such a massive change to America’s healthcare market, it included precious few specifics about such a change—like what it would cost. Sen. Bernie Sanders (I-VT), perhaps single-payer’s biggest supporter, serves as the ranking member of the Senate Budget Committee. If he asked the budget scorekeepers to analyze his legislation in full to determine what it would cost, and how to go about paying for the spending, CBO would give it high-priority treatment. To the best of our knowledge, that hasn’t happened.|
To pay for Medicare for All, Democratic presidential candidates have focused on taxing the rich. But many of the plans they’ve put on the table would require across-the-board tax increases that would hit middle-earners as well as the wealthy, public policy analysts say. None more than Medicare For All. Raising the more than $30 trillion needed to fund Sanders’s health plan over a decade would require doubling all personal and corporate income taxes or tripling payroll taxes, which are split between employees and employers, said Marc Goldwein, a senior vice president at the non-partisan Committee for a Responsible Federal Budget.
Democrats asked CBO to lay out some parameters of how to set up single-payer, hoping to elude analysis of any one bill in Congress. The latter would carry political accountability—and a price tag. Instead CBO walks through “key design components and considerations” in a report that aims to bore and deploys the word “could” 209 times. Yet even this limited analysis is instructive about the “major undertaking” of single payer, as CBO puts it in hilarious understatement. CBO acknowledges, for example, that a transition that includes moving 160 million people from employer-sponsored coverage to single payer would be “complicated, challenging, and potentially disruptive” to health care and the economy. You don’t say.
|People who switched from traditional Medicare to private Medicare Advantage plans in 2016 spent $1,253 less in 2015, on average, than beneficiaries who remained in traditional Medicare, after adjusting for health risk. Even among traditional Medicare beneficiaries with specific health conditions, those who shifted to Medicare Advantage in 2016 had lower average spending in 2015, including people with diabetes ($1,072), asthma ($1,410), and breast or prostate cancer ($1,517).|
Tennessee is charging ahead to become the first state in the nation to ask the Trump administration for Medicaid funding in a lump sum—a radical overhaul of the entitlement program that critics warn could force major cutbacks in healthcoverage for low-income people. State Republican lawmakers last week, emboldened by the Trump administration’s promise to provide states with more flexibility to run their Medicaid programs, approved legislation requiring Tennessee to submit a Medicaid block grant plan to the federal government within six months. The legislation now goes to Republican Gov. Bill Lee, who will sign the bill, a spokesperson said.
The U.S. does not have a “free market” health care system. 90 percent of Americans have health insurance, nearly all of whom have their coverage heavily subsidized by the government. Part of the misconception stems from the fact that 159 million Americans receive health insurance through their employers. Private coverage is not the same thing as market-based coverage. Thanks to long-standing distortions in the tax code, few workers have the opportunity to choose their own coverage in a transparent market where prices and benefits are easy to understand. Ultimately, the most important way to make employer-sponsored coverage more affordable is to evolve away from the group model and toward a system of consumer-driven, individually purchased health insurance.
Emergency medical care is an exception to the general principle of market exchange, whereby services are voluntarily bought and sold, with sellers competing on price. Under federal law, hospitals are required to treat patients that arrive needing emergency medical treatment, regardless of their ability to pay—but allowed to subsequently charge whatever they wish. In recent years, medical providers have increasingly exploited this arrangement by threatening exorbitant charges for out-of-network emergency care in order to force insurers to agree to generous reimbursement terms across the board. Patients have frequently been caught in the crossfire and forced to pay large “surprise bills” for emergency care by hospitals or doctors who remain out of network.
The Trump administration announced that it has finalized a new rule requiring all drug companies to include the list prices of their drugs in direct-to-consumer advertisements. If sunlight is the best disinfectant, the White House hopes that more visibility about drug prices will hold drugmakers more accountable and reduce costs for patients at the pharmacy counter.