Beth M. Cubriel
Principal at Michael Best Strategies LLC
House and Senate members have returned from their summer recess, which started at the beginning of August and ran through Labor Day. Let’s take a look at the major health care policy matters that are on deck for consideration before lawmakers return once again to their districts at the end of the year.
Surprise Medical Billing
During the August recess, members of Congress were greeted in their districts by ads purchased by physician advocates. These ads, which arrived in mailboxes, and ran on TV and radio, encouraged the public to contact members of Congress to let them know that surprise medical billing reform hurts doctors and hospitals. One ad campaign compared benchmark pricing – one of the proposed solutions to surprise billing – to “government rate-setting” and warned that surprise billing reform could cause hospitals to close. But according to the Kaiser Family Foundation, the majority of the public (57%) still supports such reforms, despite seeing or hearing the ads.
As for reform, there are two approaches. The first, as noted above, would establish “benchmark pricing,” requiring out-of-network hospitals and physicians treating emergency cases to bill at the average in-network rate since the patient doesn’t have the choice of hospital or caregiver in such circumstances. This is the approach generally favored by employers and is included in legislation being considered in both the House and Senate.
The second approach is arbitration, meaning that if the provider doesn’t want to agree to the benchmark, they can use a dedicated appeal system to negotiate a different price for the insurance company. This concept, currently opposed by the administration and by most employer groups, has some popularity in both chambers and is being described as a “backstop” for when benchmark pricing is deemed unacceptable or unworkable by providers.
Before August recess, the House overwhelmingly passed HR 748, including a permanent repeal of the Cadillac Tax, by a vote of 419-6. The fate of the repeal is now in the Senate, where Majority Leader Mitch McConnell has been quiet on any commitment to bring the vote to the floor. Since the bill enjoys political support from consumers, employers and labor unions, it is expected to pass should it receive a floor vote. Repeal of the tax is expected to add $197 billion to the federal deficit over the next decade, however, which makes Congressional leadership very nervous.
Shortly after returning from the recess, House Speaker Nancy Pelosi released details for her long-awaited bill on prescription drug reform. The proposal would, among other measures, require the federal government to negotiate 250 different brand name drugs offered through Medicare. Pelosi’s reform is supported by many Democrats and even enjoys the support of President Trump, who has expressed his support for efforts designed to deliver relief to consumers. But the bill is opposed by progressive Democrats, who argue it doesn’t do enough, and by almost all Republicans, who have described it as “socialist” and “dead on arrival” in the upper chamber.
With prescription drug reform being identified as a “priority” issue by 70% of the electorate, and with the issue likely to continue to be a topic of discussion heading into next year’s presidential election, members of Congress have plenty of motivation to find common ground. If a bill moves, it likely will be a hybrid of the Pelosi bill and the Senate bipartisan plan that would cap out-of-pocket expenses for certain seniors and limit drug price increases to the cost of inflation.
What’s most likely* to move?
Of these three much-needed health care policy changes, I expect that some sort of surprise medical billing reform has the best prospects of becoming law before the end of the year. It’s the issue on which there is most agreement, although the aggressive lobbying effort by physician advocate groups over the summer has softened congressional resolve somewhat. Prescription drug reform is best primed for next year. There is political pressure for change but lawmakers from each party, and within the two parties, have very different solutions and expectations. Finally, there is as yet no easy solution the high price tag associated with Cadillac Tax permanent repeal, and its fate in the Senate remains in doubt.
*Update -- on September 24, 2019, House Speaker Nancy Pelosi announced that the House would open a formal impeachment inquiry into President Trump. While the impact of this development on the regular legislative business of the Congress is still unknown, it is reasonable to assume that nothing requiring bipartisan cooperation will move quickly until the two parties decide how to work through this inquiry.
Learn More About Health Care Policy
Who Stands For What? Breaking Down the Democratic Presidential Candidates' Health Care Proposals.
Alliance Members can influence health policy. Here’s how.
Read The Alliance health policy platform.
What is surprise medical billing? When it Comes to Surprise Bills, Congress Should Side with Consumers.
Why You Should Get Involved
The Alliance encourages its member-employers to get involved and share their perspectives with their elected representatives, particularly members of Congress given that so many policy issues are handled by the U.S. Congress and federal agencies.
Beth Cubriel with Michael Best Strategies shares her perspectives on how best to build relationships and share information with members of Congress. Beth worked for many years for United States Senator John Cornyn.
Time to Meet Your Member of Congress!
Here are some tips on how you can build a trusted relationship with your member of Congress and in so doing make sure that The Alliance’s health policy priorities are well understood by those members.
Know Who Represents You. The first step in establishing a relationship with your elected representatives is to know who they are and how to reach them. You can look up your House member and senators and find their offices’ contact information here: https://whoismyrepresentative.com/
Call the office. Generally speaking, this is an easy but relatively ineffective method of communication. Calls into members’ offices get logged as a position for or against a particular issue. There are no supporting arguments or rationale relayed with your position and you will not get a response from the member. The only time that calls into offices work is if they are done en masse, potentially encouraging a member who is on the fence.
Write letters/emails. For the activist with limited time, a letter or email can be very effective, especially if you have a unique story to tell. When writing your letter, be sure to let your representative know you are an employer in his or her district and that a vote they are about to take not only affects your ability to run a successful business, but also affects your employees. If appropriate, ask your employees to send letters of their own. Some Congressional offices have a policy to respond to all received correspondence. The response is almost always drafted by a staff member but includes language that is approved by the member.
Meet with staff in the district. When I worked in the state offices for Sen. Cornyn, we met with constituents all the time. They came to our office; we attended their events; we got to know them. These are the people we would often proactively call for their opinion on a topic. They became opinion leaders for us in their particular field. We would report back to the senator so that he could better understand the perspectives of the business owners, law enforcement, teachers, etc. in the state.
Attend events. When you know that a Congressional recess is approaching, call the member’s office and ask if they have any public events you can attend. Unfortunately, because the political climate has gotten so hostile, the public town hall meeting has become a thing of the past. But if you get to know the staff, they will likely be more forthcoming with you about opportunities to connect with the member. Conversely, if you’re a member of an association or chamber of commerce, ask them to invite your member to speak to your group. Or, invite the member to visit your business and meet your employees.
Engage on social media. Want your member to Fight the 40, also known as the Cadillac Tax? Tag them when you re-tweet Fight the 40s twitter feed, letting them know you are a constituent and employer in their district. Say something like “This constituent wants to know if @JohnSmith will support workers in the district by fighting the 40.” Or, if your member has already voted to repeal the Cadillac Tax, a quick tweet to say thanks is always helpful. Just stay within the character limits and avoid being combative!
Travel to Washington, D.C. If you happen to be taking the family to D.C., be sure to check in with your member before you go. They can be helpful in scheduling tours and most members will have a weekly meet and greet, a time when visiting constituents can snap a photo with the member.
Help the campaign. If you are inclined, attend a fundraiser or volunteer for your member’s campaign. You’ll have to go to the member’s campaign website to get involved politically. That information can usually be found by Googling “John Smith for Congress” or “Jane Doe for Senate.”
I Can Help!
Please let me know if you have any questions about these suggestions. I’ve worked on both sides of constituent-member relationship, both as a Senate employee and as an issue advocate. I’m happy to review correspondence, track down the most relevant contact information, or answer any questions you might have about forging a trusted relationship with your elected official. You can contact me at email@example.com.
Learn More About Current Policy Issues
Read the blog: "Health Care Policy Returns to Center Stage in Washington D.C." or "Who Stands for What? Breaking Down the Democratic Presidential Candidates' Health Care Proposals"
Check out what’s new in health policy initiatives and information at The Alliance.
Our resolutions are formal policy statements related to the legislative landscape that are developed within the parameters of The Alliance’s health policy platform.
Learn the impact of surprise medical billing from out-of-network providers, the politics of reform and what reform is happening in the United States.
Ever since the U.S. Supreme Court upheld major portions of the Affordable Care Act (ACA) in 2012, health care providers, insurers and employers have been closely monitoring congressional and executive action to forecast the future of the law and its many provisions. The Dec. 14, 2018 ruling by a federal district court judge in Texas, Reed O’Connor, once again throws judicial action into the forefront of that mix.
A recent Google search for “opioid crisis” produced 90 million results, an indication that America’s addiction to opioids has gained serious media attention over the last several years.
Two bills designed to promote transparency in the sale of prescription drugs by banning pharmacy “gag clauses” were passed by Congress and signed into law by the President this month.
Onsite clinics are a growing trend for American employers. Today, 50 percent of employers with over 5,000 employees have onsite or near-site clinics, according to the National Association of Worksite Health Clinics. It’s predicted that in the next two years, this percentage will grow to two out of three.
July has been a busy month for those keeping up with changes to health care law and policymaking. Here is an overview of some recent action by the administration and Congress.
On Friday, May 11, President Trump delivered a highly anticipated speech to outline his plan to reduce drug prices and the cost of health care in America. The President gave a speech that was high on platitudes, promising to “launch the most sweeping action in history to lower the price of prescription drugs for the American people.”