HLTH was certainly the biggest health conference I’ve ever been to in my 30+ years at Mercer, and what made it so invigorating was the opportunity to hear from such a wide range of stakeholders. I hosted a panel discussion on health policy issues with two Washington insiders: Katie Mahoney from the US Chamber of Commerce, representing the interests of American business, and Kim Monk from Capital Alpha Partners, who works with investors in the healthcare space.
Time was limited so we did a “fast policy countdown” to cover as many issues as we could. To boil it down even further for you, here are the hottest two topics we discussed.
Medicare for All
There are at least 10 proposals being discussed that would expand Medicare in some way, ranging from Medicare for All, which would provide cradle to grave coverage, replacing all other sources of insurance, to Medicare Buy-In, where people ages 50-64 have option to buy into Medicare (note: this is not the same as lowering the age for Medicare eligibility). There are also proposals for a Federal public plan option and for a public program with opt-out. What employers need to know now:
- Remember these are all political campaign proposals, some with more details than others. What is said on the campaign trail may not exactly translate to future health policy or law – but we still need to pay attention.
- For major change to occur, the House, Senate and White House would need to be controlled by one party, which does not look likely for 2021.
- Provider reimbursement is a key question. Medicare provider payment rates are significantly lower than private insurance rates, and some argue that if all providers were reimbursed at current Medicare levels, hospitals would struggle financially.
- Smaller changes, such as Medicare Buy-in, could result in greater cost shifting to private payers because more people are accessing care at Medicare reimbursement levels.
- Proposals that allow employer coverage to remain in place may come with requirements and restrictions that could be costly to employer plans.
- The bigger the change, the bigger the price tag for taxpayers and businesses.
Surprise Medical Bills
“Surprise” medical bills can arise after the patient’s health plan pays benefits under the terms of the plan, but then an out-of-network provider bills the patient for the difference between the amount paid by the plan and billed charges. On Capitol Hill, lawmakers are struggling to find consensus on how to stop surprise bills amid a fierce lobbying fight between employers and insurers. Employers are backing legislation that would set benchmark payment rates for out-of-network services based on the median in-network rate in the area, while medical provider groups are pushing proposals to use arbitration to settle payment disputes. What employers need to know now:
- Arbitration would likely cost medical plans more, because providers would be able to negotiate for higher reimbursement than what is currently being paid by the plan in exchange for not balance billing the patient. This could provide a financial incentive for providers to drop network participation.
- Don’t underestimate the power of self-insured employers to get the market to end surprise medical bills! Demand more accountability from your health plan partner and let them put pressure on the network to deliver.
- Some employers are adding language in their open enrollment and other communications to help employees and their families “know their rights” when they get a balance bill.
So many issues, so little time! I’ll end with the key takeaway of the session: The biggest stakeholder in the health care system are employers. You pay most of the health care bill for 181 million Americans (about 56% of the population). And while this is commonly referred to as health insurance, most employees are in self-funded plans -- meaning the employer is carrying the risk. The employer voice needs to be heard on Capitol Hill in these critical policy discussions. Join us!