Health care is one of the most dynamic, decisive—and often divisive—topics in politics today. From the hospital room to the courtroom, the policies passed in legislative sessions impact how we stay healthy, and how we choose and pay for care. Here’s a breakdown of some of the most significant decisions and trending conversations impacting health care this year and as we head into the 2020 election season.
Vaping and e-cigarettes
Once touted as a safer alternative to smoking cigarettes, health studies have quickly revealed that vaping nicotine is among the most dangerous trends in health, especially with younger people. And while vapers aren’t combusting an actual flame, the dose of nicotine ingested in a typical vaping device is considerably high. Most manufacturers equate one e-liquid nicotine pod to a pack of paper-burning cigarettes. Given the ease and facility of vaping devices, many teenagers smoke through these pods at alarming speeds.
“Given the ease and facility of vaping devices, many teenagers smoke through these pods at alarming speeds.”
As news reports have arisen of serious illnesses or deaths connected to vaping, the Trump administration has moved to restrict the sales and marketing of flavored e-cigarettes and vaping products. The governors of New York, Rhode Island and Massachusetts have taken executive action banning or limiting vaping and e-cigarette products. Connecticut is also contemplating action. Requirements under the Affordable Care Act and state law mandate health plans provide resources for nicotine alternatives and smoking cessation. Those resources will be more in demand as the bans take effect. Information on the nicotine alternatives benefits provided by Harvard Pilgrim Health Care can be found here.
The Harvard Pilgrim Health Care Foundation and Boston Children’s Medical Center recently announced a research and grant collaboration to develop a training manual and protocol for primary care providers and counselors to treat vaping addiction in youth, and provide ongoing consultation for treatment and prevention. More information can be found here.
Over the summer, President Trump signed an executive order titled “Improving Price and Quality Transparency in American Healthcare to Put Patients First.” This order proposes regulations around price transparency. Drug companies and hospitals are being asked to roll out plans to begin revealing the costs for drugs and medical services up front, like most other goods. The Department of Health and Human Services expects that increased transparency will lead to more competition, and ultimately reduced costs for the patient.
“Drug companies and hospitals are being asked to roll out plans to begin revealing the costs for drugs and medical services up front, like most other goods.”
Generally speaking, the executive order directs an array of federal agencies to adopt rules, issue guidance, or develop reports with the goal of increasing the transparency of health care price and quality information.
This is only an executive order and is not itself a change in law or regulations. Rather, it is a directive to draft new rules or guidance. From here, various agencies will have to develop and publish proposed rules, and then receive and respond to public comments before finalizing the rules. This process could take months, if not years. Only then would the changes go into effect.
Health reimbursement arrangements
Also happening this past summer, the U.S. Departments of Health and Human Services, Labor, and, Treasury issued a final rule to allow employers to fund employee premiums in the individual health insurance market by using tax-advantaged health reimbursement arrangements (HRAs). Employers, particularly small businesses, may view this initially as providing increased flexibility in how they offer health insurance benefits to their employees, although how it will impact the landscape of both the group and individual markets when it comes to health insurance remains to be seen. In New England, state insurance regulators have begun to hold listening sessions and convene meetings of stakeholders to understand the impacts on the insurance markets in various states.
Balance, or “surprise,” billing
Surprise billing, also referred to as balance billing, happens when a patient receives care from a doctor or hospital outside of their insurer’s network. Subsequently, the doctor or hospital bills the patient for the amount that insurance didn’t cover. This out-of-network bill will catch the patient by “surprise,” as it usually appears in multi-specialist procedures or surgeries, where an attending specialist could be an out-of-network provider, while the hospital or the facility providing treatment is considered in-network for the patient.
Often, providers are not notifying patients about out-of-network services, which can lead to months of frustrating phone calls, paperwork and collection efforts. There are currently a number of bills and committees in Congress all attempting to address the issue.
“Surprise billing, also referred to as balance billing, happens when a patient receives care from a doctor or hospital outside of their insurer’s network.”
Mental health has been at the periphery of many weighty subjects making headlines, from teen depression to gun control. As these conversations continue to evolve, it’s become clear to many that increasing access to mental health resources is a critical issue.
In 2008, the Massachusetts Department of Public Health instituted a policy for all facilities that receive any state funds, known as the “No Wrong Door” (NWD) policy. The NWD policy was to “embody an approach of ensuring anyone suffering from substance use disorder is able to get the help they need, when they need it. NWD is a protocol ensuring no requirement that a patient must enter the treatment and recovery system through ATS (detox) alone”. The policy is receiving renewed interest, as the initiative complements the Baker-Polito administration’s broader, ongoing efforts to create a behavioral health system in Massachusetts. Since 2015, the administration has prioritized the importance of improving access to behavioral health services across the spectrum of treatment for mental illness, addictions, and co-occurring illnesses.
“The No Wrong Door approach to mental health seeks to treat anyone in need, regardless of their entry into the health care system.”
The No Wrong Door approach to mental health seeks to treat anyone in need, regardless of their entry into the health care system. Whether the need is for a doctor, a specialist, an ER, or urgent care, in this approach a patient will be navigated to those resources regardless of what “door” they came through for medical care. Providers are also seeking ways to increase the volume of specialists available for in-network mental health services. Often, geography and network are playing too great a role in a patient’s ability to get needed services.
We can expect a number of legislative proposals in Massachusetts this fall, with the focus on mental health continuing into the next year and likely also occurring during the legislative sessions in other New England states.
Texas vs. United States
In the presidential administration’s ongoing efforts to repeal the Affordable Care Act (ACA), Texas vs. United States seeks to abolish the ACA on the grounds of unconstitutionality, citing the mandate that all people must have insurance. A countersuit by Maryland’s attorney general to protect the ACA was dismissed on the grounds that it failed to provide evidence of the administration failing to enforce the act. If evidence is produced, the state could revive the suit. Both suits continue to wind their way through the court system, toward a potential review by the U.S. Supreme Court.
With the 2020 presidential election cycle on our immediate horizon, Harvard Pilgrim’s Government Affairs team will continue to keep an eye on these narratives as they continue to develop and evolve, and will communicate updates that have the potential to impact our markets. For more resources relevant to your business and client needs, visit here.