New CBO report shows increased demand for primary care services

At the agencies

The Congressional Budget Office (CBO) issued a new report that shows an increased demand for primary care services over the last decade. Increases in the number of insured and an aging population are the primary drivers for the increase. Continuing this trend, CBO estimates that demand for services will further increase 18 percent through 2023, although healthcare reform may impact those predictions.

The Department of Health and Human Services (HHS) has been asked by a coalition of doctor, insurer and patient groups to adopt site neutral payment reforms in Medicare. The requested change in payments would reduce the discrepancy between the Medicare payments received by hospitals and off-campus providers. The coalition notes that changes to this rule would help curb provider consolidation and stop Medicare from reimbursing procedures at significantly different rates simply because of where the procedure was done.

HHS has released new funding to address the opioid crisis, dedicating $70 million in grants to providers and communities to prevent opioid-related deaths and to provide treatment options to those with an opioid use disorder. This $70 million is in addition to the grants provided by the 21st Century Cures Act, which offer $485 million to opioid abuse prevention, treatment and recovery.

The Trump administration may reverse course from an Obama-era regulation that banned nursing homes from requiring patients to agree to binding arbitration. Currently, the arbitration rule bars nursing homes that receive Medicare and Medicaid funding from requiring patients to give up their right to sue. Although this rule was adopted last year, it has not been in effect because nursing home industry groups secured a temporary injunction blocking enforcement of the rule. In a newly proposed rule, the Centers for Medicare and Medicaid Services (CMS) has suggested that an absolute ban on binding arbitration agreements does not adequately balance the pros and cons of arbitration, and that requiring “plain language” descriptions of the agreement to binding arbitration, for example, may be a better solution.

On the Hill

The three planned phases of Affordable Care Act (ACA) repeal are: (1) pass a repeal package through reconciliation, (2) weaken the ACA through executive actions that the Secretary of HHS Tom Price may take and (3) pass additional healthcare bills that would address the aspects of repeal and replace that could not be accomplished through reconciliation. Part 1 of the plan is facing difficulty (described below), part 2 is moving at a slower tempo but has the potential to ramp up as Secretary Price has more time and more staff to affect rule changes and part 3 is just getting started.

The Senate Parliamentarian may issue a major setback to passage of the American Health Care Act (AHCA). Since the Senate Republicans hope to pass the AHCA through a process known as reconciliation, which must meet a series of strict requirements, the Senate Parliamentarian must assess each aspect of the AHCA to determine whether it may appropriately be passed via reconciliation. Reconciliation is the sought-after process, because it requires 50 (instead of 60) votes (assuming that the Vice President will issue the tie-breaking vote to secure passage of the Act.) One critical aspect of the AHCA, as currently drafted, includes language that would strip abortion funding, a provision which has won the support of pro-life advocacy groups and conservative GOP members. This section, which some see as critical to passage of the AHCA, may be deemed inappropriate for reconciliation by the Senate Parliamentarian, which would mean that the section needs to be redrafted or dropped entirely from the bill, threatening to lose needed votes.

In addition to the obstacle posed by the Senate Parliamentarian, negotiations on Medicaid continue to slow progress of the AHCA. However, a growing coalition of senators supporting a seven-year glide path to ending Medicaid expansion suggests compromise may be possible.

The chairman of the influential House Ways and Means Committee, Rep. Kevin Brady (R-TX), has called for Congress to immediately provide for cost-sharing reductions (CRSs) “temporarily and legally” as Congress works to repeal and replace the ACA. To date, the administration has been unwilling to commit to fund CSRs, causing uncertainty in the individual insurance market. Chairman Brady’s statement comes on the heels of an announcement from House Republicans that they are working on a bill to temporarily fund CSRs and stabilize the market while work on ACA repeal is underway.