Tuesday Tidbits

The House of Representatives passed today the two final FY 2020 spending bills (HR 1158 and 1865), which include provisions repealing the three ACA taxes that raise health care costs -- the medical device tax, the health insurer tax, and the high cost employer plan, or Cadillac, tax. Sen. Lamar Alexander, the chairman of the Senate Health Education Labor and Pensions Committee, announced that the spending bills also include the following four provisions from his Committee's bipartisan bill to lower healthcare costs, S. 1895.

• CREATES Act—increase generic drug competition and lower the cost of drugs
• Insulin—two provisions to increase biological drug competition and lower drug costs, including in the insulin market
• Tobacco-21—raise purchasing age of tobacco to 21
• Kay Hagan Tick Act—better protect Americans from diseases transmitted by ticks, mosquitoes and fleas

The Senate is expected to approve the two spending bills later this week and the President is expected to sign the bills into law before the current continuing resolution funding the federal government expires on December 20. This action of course would avoid a federal government shutdown.

The Senate today joined the House in approving S. 1790, the FY 2020 national defense authorization act, which the President is expected to sign into law. This is the bill that creates a paid parental leave program for federal employees, requires an independent study of the Administration's plan to dismantle OPM and creates protections for federal employees in the event of another long government shutdown.

Sen. Alexander in his announcement reiterated his support for legislatively resolving the surprise bill issues in the U.S. Health Affairs reports in this regard that

When physicians whom patients do not choose and cannot avoid can bill out of network for care delivered within in-network hospitals, it exposes patients to financial risk and undercuts the functioning of health care markets. Using data for 2015 from a large commercial insurer, we found that at in-network hospitals, 11.8 percent of anesthesiology care, 12.3 percent of care involving a pathologist, 5.6 percent of claims for radiologists, and 11.3 percent of cases involving an assistant surgeon were billed out of network. The ability to bill out of network allows these specialists to negotiate artificially high in-network rates. Out-of-network billing is more prevalent at hospitals in concentrated hospital and insurance markets and at for-profit hospitals. Our estimates show that if these specialists were not able to bill out of network, it would lower physician payments for privately insured patients by 13.4 percent and reduce health care spending for people with employer-sponsored insurance by 3.4 percent (approximately $40 billion annually).