Seligson also got a firsthand report from Brad Wilson, CEO of Blue Cross and Blue Shield of North Carolina on the major health insurers’ meeting with President Donald Trump, Vice President Mike Pence and US Secretary of Health and Human Services Tom Price, MD and other leaders in the Trump administration.
“Brad told me that they discussed ways to stabilize the ACA marketplace for 2017-18 to enhance the likelihood that insurers can stay in the market,” Seligson said. “The rules CMS proposed a couple of weeks ago, if approved and implemented, would be a good first step. Brad was hopeful that the positive discussions that occurred last Monday will continue.”
[Read the Bulletin article on the CMS proposed rule referred to above.]
Over the course of his three days on the Hill, Seligson met with members of the NC Congressional Delegation including Rep. David Price (D-4th district), Rep. George Holding (R-2nd district) and had a lengthy meeting with Sen. Richard Burr, in which the senator outlined some of the provisions he thought would be considered in the legislation.
Along with other state medical society leaders, Seligson also met with Rep. Michael Burgess, MD, (R-Texas), who chairs the powerful House Energy and Commerce Committee’s Health Subcommittee as well as Rep. Kevin Brady, chairman of the Ways and Means Committee and staff of Sen. John Cornyn, who is the majority whip and serves on the Senate Finance Committee. These are the crucial committees where the repeal and replace bills will be heard.
Late Monday, the House introduced its repeal and replace legislation. Read the bill. The proposal would eliminate the individual and employer mandate penalties for not having health insurance coverage, would preserve the provisions that prohibit insurers from denying coverage or charging more for pre-existing conditions and provide tax credits for those who cannot afford or do not receive health insurance through their employer.
This week it is expected the House Energy and Commerce Health Subcommittee will be considering hundreds of amendments to the proposed repeal bill and the House Ways and Means committee will be reviewing and considering several tax provisions. It is anticipated by the end of the week a marked up bill will be made available outlining the proposed changes. The Senate may be considering a separate bill.
“A lot of behind the scenes negotiations are going on,” Seligson said. “It is expected that the democrats will offer a lot of amendments to the bills in each chamber. They are expected to be put on a fast track, but may be slowed down due to lack of consensus and debate in the key committees.”
While much remains uncertain at this point, the NCMS advocated strongly that any ACA repeal and replace legislation include, but not be limited to, the following:
- Ensure Americans do not lose coverage;
- Improve patient access to physicians;
- Continue tax policies and subsidies that help low- and moderate-income patients afford coverage;
- Allow patients a broad choice of physicians, plans and coverage through Health Savings Accounts, private insurers, government programs and Medicare private contracting;
- Maintain the important insurance reforms that protect physicians and their patients, such as coverage for pre-existing conditions;
- Stabilize the individual insurance market;
- Allow each state to choose the best Medicaid options for their state;
- Provide access to affordable prescription drugs.
Other issues addressed with the legislators included alleviating federal bureaucratic burdens on physicians. The coalition of state medical societies asked that Congress:
- Impose a 2-year moratorium on new regulatory requirements of physicians’ practices.
- Require true interoperability among electronic health records to allow physicians, hospitals, labs and health plans to exchange vital health care information simply and inexpensively.
- Require Medicare and Medicaid to arrange for and cover the cost of interpreters.
RAC audit legislation also was addressed as the Medicare RAC audit contractors are more forcefully espousing that the audits are crucial to saving money. Seligson and the other medical society coalition members explained that nearly half of all audit findings are overturned by an administrative law judge when a physician appeals. The RAC audit program desperately needs reform and the Coalition asked Congress to:
- Prohibit RACs from recouping physician payments until the appeals process is final.
- Make RACs more accountable for improving extrapolation formulas and employing reviewers trained in the same medical specialty as the physicians they review, and impose penalties for inaccurate findings.
- Provide incentives for RACs to educate physicians about any incorrect billing practices to avoid future billing errors.
Watch the NCMS Legislative blog for updates on these federal issues.