United States: What's New In Washington - June 2019

The summer season has arrived in Washington and things are heating up in the halls of Congress. A number of high priority legislative proposals ranging from health care to appropriations to patent reform to defense authorization continue to drive the policy agenda while a number of investigations focused on President Trump and his administration continue to play out in the political arena. In the House, Democratic investigations have taken priority while the majority's leadership debate the consequences of possibly moving forward with impeachment proceedings against the President. In the Senate, Republican leadership is working expeditiously on a number of judicial and executive nominations while trying to navigate the ever­changing tariff battles between President Trump and Congress.

While the Senate will continue to focus on approving presidential nominations, we also expect floor time this summer on a number of legislative items, including appropriations bills and drug pricing. This is likely to be a welcome change for some senators who have become more vocal with their frustrations over the lack of movement on policy priorities. In the House, Speaker Nancy Pelosi (D-­CA) continues to balance the political desires of her voter base and caucus for impeachment proceedings with realistic expectations, knowing the GOP-­controlled Senate would not move forward with any effort by the House, and the possibility that impeachment proceedings would energize the President's voter base heading into the 2020 election. However, what was once a strictly partisan issue turned bipartisan as Rep. Justin Amash (R-­MI) became the first member of the GOP Conference to join Democratic calls for President Trump's impeachment.

While a deal on budget caps remains elusive, talks continue between congressional leaders and the administration with a relatively optimistic outlook for reaching a deal that would address the Budget Control Act spending caps for FY 2020 and 2021, as well as a further suspension of the debt limit, which expired on March 1, 2019. House Appropriations is plowing through its work, with the first minibus package of several bills expected to reach the House floor this week. The Senate is expected to begin marking up appropriations bills later in June. Another area that has seen progress is the annual defense policy bill, the National Defense Authorization Act (NDAA) for FY 2020, which was marked up in the Senate Armed Services Committee in May and will head to a full committee markup in the House next week. NDAA is expected to be on the Senate floor the week of June 17 and on the House floor later this summer.

A disaster aid package that seemed poised for passage prior to Memorial Day recess was temporarily delayed by a few unsatisfied House Republican members, but was eventually passed on June 3. The bill, which also included a four­month extension of the National Flood Insurance Program, has been signed into law by the President.

On June 7, President Trump announced a deal with Mexico that would "indefinitely suspend" the tariffs he had threatened on all imports from that country just a week earlier, unless it took actions to "alleviate" the "illegal immigration crisis." The President's tariff strategy had been strongly criticized by the business community and members of both parties in Congress, who briefly considered voting to end the President's emergency declaration and its tariffs. The eight day standoff distracted from the push to pass the U.S. ­-Mexico-­Canada Agreement (USMCA), which had seen procedural advances in recent weeks.

IN THIS ISSUE

Congress is moving ahead with legislation to address so­called surprise medical billing, an effort that has the support of the administration and committee leaders in both chambers. On May 9, President Trump held a White House event on surprise billing, announcing four broad principles to guide Congress in developing legislation on the issue: i) out-­of-­network balance billing should be prohibited for emergency care; ii) patients should be given prices and out­-of­-pocket costs in advance of scheduled, non­emergency care; iii) patients should not receive bills from out­of­network providers that they did not choose themselves; and iv) legislation should protect patients without increasing federal expenditures or reducing patient choice.

Lawmakers have released a number of bills and draft bills, nearly all of which aim to shield patients from out-­of-­network rates when receiving emergency care or when being treated by an out­of­network provider at an in­network facility. The various proposals take different approaches to the issue of determining reimbursement for providers in these scenarios. However, a bipartisan group of senators led by Sen. Bill Cassidy (R­LA) released its muchawaited legislation, the Stopping The Outrageous Practice (STOP) Surprise Medical Bills Act (S. 1531) or the "Cassidy Bill", under which providers would automatically be paid the difference between the in­-network cost­sharing amount and the median in-­network rate under the plan. Providers and plans would be able to appeal this amount through a "baseball-­style" arbitration process. House Energy and Commerce Committee Chairman Frank Pallone (D-­NJ) and Ranking Member Greg Walden (R­-OR) released their own draft surprise billing legislation, the No Surprises Act, on May 14. The bill would set a minimum payment amount based on the median contracted in­network rate in the geographic area where the service was delivered.

On May 23, the Senate Health, Education, Labor and Pensions (HELP) Committee released its draft legislation, the Lower Health Care Costs Act. In addition to provisions related to drug pricing, health information exchange and transparency, the draft bill includes a section on surprise billing that outlines three possible approaches to payment determinations. Under the first option, in­network facilities would guarantee to patients and plans that every practitioner at the facility would be considered in­-network. For emergency care delivered out-­of­-network, providers and facilities would have 30 days to determine private reimbursement with the health plan. If no agreement is reached, the provider would be paid based on the median contracted in­network rate for services in that geographic area. Under the second option, for bills of $750 or less the health plan would pay the provider based on the median contracted in­network rate for services in that geographic area. For bills greater than $750, the plan or provider can elect to initiate a baseball­style arbitration process. Finally, under the third option, the health plan would simply pay the provider based on the median in­network contracted rate for services in that geographic area. The legislation also requires bills for air ambulance services to be broken out by air transportation and medical charges.

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