Overnight Health Care — Presented by PCMA — Senators unveil sweeping bipartisan health care package | House lawmakers float Medicare pricing reforms | Dems offer bill to guarantee abortion access

Welcome to Thursday’s Overnight Health Care.

It was a bipartisan kind of day in health care. The Senate’s top health care leaders introduced their package aimed at lowering health care costs, while over in the House, Republicans and Democrats released drug pricing reforms.

We’ll start with the Senate’s bipartisan plan…

 

Alexander and Murray reveal sweeping health care package

Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) released their long-awaited package to lower health care costs on Thursday. And there’s a lot in it:

Some of its major provisions would:

• End surprise medical bills. The proposal lays out various options, but all would protect patients from getting massive medical bills when they go to the emergency room and get care from an out-of-network doctor.
• Create more transparency around pharmacy benefit managers, sometimes known as drug “middlemen” to ensure they are passing along discounts on drugs to customers.
• Prevent certain anti-competitive clauses in contracts between medical providers and insurance companies that can drive prices up.

The path forward: Alexander is hoping for committee action in June and a Senate vote in July. The package could be combined with another bipartisan health care package, on drug prices, that Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) are working on in the Finance Committee.

“These are common sense steps we can take, and every single one of them has the objective of reducing the health care costs that you pay for out of your own pocket. We hope to move it through the health committee in June, put it on the Senate floor in July and make it law,” Alexander said.

Read more on the package here.

 

 

Bipartisan House members unveil surprise billing legislation

Momentum is building for a legislative solution to surprise medical bills … but so far, we have only seen disparate pieces of legislation. The latest bill introduced on Thursday was led by Reps. Phil Roe (R-Tenn.) and Raul Ruiz (D-Calif.). The lawmakers called it an “outline” of a bill, with a final version to follow in the coming weeks.  

The legislation is more in line with the Cassidy/Hassan legislation in the Senate than it is with the other bipartisan House bill introduced less than two weeks ago by Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) and ranking member Greg Walden (R-Ore.).

The differences: Not surprisingly for legislation sponsored by two doctors, the Roe/Ruiz bill calls for arbitration between an insurer and provider when parties can’t agree on what the in-network rate should be.

Meanwhile, the Walden/Pallone legislation would require insurers to pay based on the price paid to nearby in-network providers.

The fact that there are now multiple versions of surprise billing legislation shows that there’s a definite desire to solve the problem. But it also means lawmakers have issues to work out. The legislation from the leaders of committees with jurisdiction over health care will likely carry more weight, though President Trump is likely to sign anything that makes it through both chambers in order to declare victory.  

 

And in other bipartisan health care action….

 

House committee leaders release Medicare drug pricing reforms

The drug pricing action is heating up, with more movement on Thursday in the House.

The chairmen and ranking members of the House Ways and Means and Energy and Commerce Committees jointly requested feedback on a bill to reform how Medicare Part D pays for drugs.

The bill would:

• Cap seniors’ out of pocket costs for drugs in Medicare
• Change the incentives in the program by reducing the share of costs the government has to pick up for high-cost enrollees.

What’s notably missing: Allowing Medicare to negotiate drug prices, which would lose the support of the Republican lawmakers. Instead, this bill focuses on changes to Medicare drug coverage that get bipartisan support.

Read the bill here.

 

Democrats introduce bill to guarantee abortion access

Bills introduced in the House and Senate Thursday would ban states from passing abortion restrictions that are “medically unnecessary” and interfere with a woman’s ability to get an abortion.

The state laws that would become illegal under the “Women’s Health Protection Act” include bans on abortion after 20 weeks of pregnancy, measures requiring ultrasounds before abortions and law requiring multiple trips to the clinic before obtaining an abortion.

“As extremist lawmakers viciously attack women’s reproductive rights in statehouses across the nation, the Women’s Health Protection Act has never been more urgent or more necessary,” said Sen. Richard Blumenthal (D-Conn.), the lead Senate sponsor of the bill.

Reps. Judy Chu (D-Calif.), Marcia Fudge (D-Ohio) and Lois Frankel (D-Fla.) introduced the House version of the bill, which has 171 co-sponsors. The Senate version has 42 co-sponsors.

Why it matters: This bill is specifically aimed at states like Alabama and Georgia that recently passed bills restricting access to abortions.

 

CMS maintains navigator funding at $10 million

The Trump administration on Thursday announced that it was keeping the funding for ObamaCare “navigators” at $10 million for next year, the same amount as this year.

The amount is a significant decrease from the Obama administration; compared to 2016, it’s an 84 percent reduction.

Navigator programs provide outreach, education, and enrollment assistance to consumers eligible for ObamaCare and Medicaid coverage.

The total available funding will be allocated among the 34 states that use federal exchanges, with a minimum of $100,000 available to each state.

Democrats have seized on the cuts to navigators as proof of the administration’s “sabotage” of ObamaCare and have passed legislation in the House to restore the funding to its original levels.

In the funding opportunity announcement, the Centers for Medicare and Medicaid Services said it doesn’t need to spend as much money as in the early years of ObamaCare because more people know about it now.

“When Exchanges were in their infancy, and public awareness and understanding of coverage options was low, the U.S. Department of Health and Human Services (HHS) encouraged Navigators to cast a wide net and to provide intensive face-to-face assistance to consumers,” CMS said. The [exchanges] have been in operation since 2013 for the 2014 open enrollment period, and the public is more aware of the options for private coverage available through them.”

 

What we’re reading

A new Senate health package includes surprisingly aggressive drug pricing reforms (Stat News)

Fact-checking Donald Trump’s claim that drug prices are going down (PolitiFact)

Senators look for bipartisan path on health care amid House squabbles (CNN.com)

Here are the GOP’s secret talking points defending Alabama’s abortion law (Vice News)

 

SPONSORED CONTENT – PHARMACEUTICAL CARE MANAGEMENT ASSOCIATION

PBMs serve as the check against drugmakers’ pricing strategies by negotiating for consumers and clients to ensure prescription drugs are affordable. Learn how PBMs advocate for patients and payers at OnYourRxSide.org.

 

Also at The Hill

Colorado on Wednesday became the first state in the country to limit how much someone could be required to pay out-of-pocket for insulin.

The Los Angeles County Board of Supervisors voted this week to impose a one-year restriction on travel to the state of Alabama for official county business after a new law in the southern state banned abortion in nearly all cases.

The Alabama House on Wednesday passed a bill requiring doctors to try to save the life of a baby born after an attempted abortion or face up to 20 years in prison.

Arizona legislative committees on Wednesday pushed forward a bill that seeks to prevent abortions by directing $7.5 million over the next three years to adoption services and apparently funding controversial crisis pregnancy centers. 

JPMorgan Chase, the largest bank in the United States by assets, will reportedly no longer offer its services to OxyContin producer Purdue Pharma over the company’s alleged role in the country’s opioid crisis.

 

State by state

Hollywood invested big in Georgia. A new abortion law is causing some tensions. (The New York Times)

Pregnancy-related deaths are rising in Utah. Experts say extending Medicaid could help those at risk (KUER)

Pennsylvania woman was convinced she bought ObamaCare insurance. She got scammed by a look-alike website (Philadelphia Inquirer)