By Michael L. Evans and Kevin Fleming
In this Gallup poll from late 2018—and in almost every other national research poll on the concerns of American voters—healthcare ranks as the No. 1 issue. Of course, healthcare is a complex, multifaceted issue, and voter concerns include the cost, quality, and availability of care as well as the availability of insurance and coverage of pre-existing conditions. The issue was recently given even higher visibility by President Trump’s executive order of June 24 mandating improved pricing disclosure in healthcare.
This heightened interest has been spawned in large part by the fact that, for more and more Americans, healthcare has become increasingly inaccessible. This compromised accessibility is largely attributable to high costs that even the insured, many now in high deductible health plans (HDHPs), struggle to afford. Whether or not one subscribes to the notion that healthcare should be a right, this issue is at the top of voters’ minds and on the agendas of the policy-makers who represent them. The objective: a U.S. healthcare system that brings care within financial reach for all Americans.
Whether or not additional regulations are really the best solution to the healthcare issues concerning Americans, it’s evident that more regulations are on their way. For industry innovators who lean in to these changes, we believe the prospects for longer-term success are promising, even groundbreaking. The challenge is finding the right partners and technology to make the necessary adaptations quickly and without undue disruption.
Currently, there are 698 bills in Congress that reference health or healthcare. Few will receive the bipartisan support necessary to move them through Congress, and it’s likely that fewer will be signed into law by the president. Any way you look at it, the intense national spotlight on an issue that affects every American family is likely to yield some significant change.
The following are five key healthcare issues pending in Congress:
1. Patient engagement and disclosure
Many proposed bills (and the above mentioned executive order) focus on the disclosure of cost and financial information to the patient as well as the relationship between the patient, provider, and insurer—details which up to now have not always been transparent.
Cost disclosure has received a lot of focus from both the legislative and executive branches. The fact that patients do not receive information about costs up front impairs their ability to compare providers and the costs of alternative treatments. The executive order focuses on lowering healthcare costs via a variety of Department of Health and Human Services (HHS) initiatives designed to “enhance the ability of patients to choose the healthcare that is best for them.”
Legislation in Congress is focused on “surprise” medical bills. These are medical bills in which a patient unexpectedly finds one or more of their medical service providers is out-of-network and is therefore not covered or only partially covered, resulting in extraordinarily high costs.
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This bill would take the patient out of the negotiation between the provider and the insurer. Proposed by Senators Cassidy (R-LA) and Hassan (D-NH), the bill is fairly comprehensive in terms of addressing the surprise medical bills issue. One potential stumbling block is the provision that this bill would set payment rates for non-network providers, and it appears to face some opposition from the American Medical Association.