Doc pay, price transparency on Congress’ healthcare agenda
Lawmakers advanced or introduced a number of healthcare bills this week, including a bipartisan measure that would reform how Medicare pays physicians — a long-awaited policy for doctors who argue their reimbursement doesn’t keep pace with the cost of care.
Other legislation making moves in Congress include a bill that aims to improve transparency in Medicare Advantage prior authorizations and a policy that would help international healthcare professionals practice in the U.S.
The raft of legislation comes ahead of the midterm elections this year, where healthcare is expected to be a key priority for voters.
About 6 in 10 adults say they’re very or somewhat worried about affording healthcare costs, like insurance expenses or out-of-pocket spending on doctor’s visits or prescription drugs, according to a poll released Thursday by health policy researcher KFF. And about half of voters said it’s extremely important for candidates to talk about healthcare expenses and the future of Medicare as the midterms approach.
Here are five healthcare bills lawmakers advanced this week:
Lawmakers push physician pay reform
A bipartisan group of lawmakers, including Reps. Kim Schrier, D-Wash., John Joyce, R-Pa., and Greg Murphy, R-N.C., introduced a bill in the House on Wednesday that would update how Medicare pays physicians.
The Patients First Act would tie doctor reimbursement to a measure of inflation, a change supported by provider lobbies and sometimes recommended by experts who advise Congress on Medicare policy.
The bill would also create a pilot program that would pay primary care providers a per-member, per-month fee alongside some fee-for-service reimbursement, in a bid to better capture the work the primary care clinicians do, the lawmakers said.
Additionally, the legislation would create a physician task force at the CMS to develop quality metrics and limit administrative burden, increase the budget neutrality threshold for physician pay updates and require the CMS to undergo a notice and comment period for all mandatory innovation center experiments.
Provider groups applauded the proposal, saying the bill would modernize the Medicare physician pay schedule and boost investment in primary care.
“Because Medicare’s physician fee schedule influences payment rates across the health care system, these reforms have the potential to improve access to care for patients far beyond Medicare,” Stephanie Quinn, senior vice president for external affairs and practice experience at the American Academy of Family Physicians, said in a statement Wednesday.
Two Medicare Advantage bills move forward
The Improving Seniors’ Timely Access to Care Act, a measure that aims to improve transparency and speed prior authorization in MA, advanced to the full House Wednesday.
The House Ways and Means Committee unanimously voted 42 to 0 to move the bill forward.
The bill, introduced last year by a bipartisan group of lawmakers in the House and Senate, would require MA plans to adopt an electronic prior authorization system, clarify regulators’ authority to set timelines on prior authorization decisions and mandate HHS agencies report on electronic prior authorization oversight and progress.
The legislation comes as prior authorization has become a significant issue for lawmakers and regulators. Providers have long complained that prior authorization delays needed care and heaps administrative work on clinicians, but payers defend the utilization management practice as a method to keep costs down.
Still, a number of insurers say they’ve cut back on the preapproval for care after a push from the Trump administration and are working to standardize electronic data submission requirements for medical services commonly subject to prior authorization.
Additionally, the House Ways and Means Committee advanced another MA bill Wednesday. The Medicare Advantage MLR Transparency Act, which would require plans to publicly disclose detailed information on how much of their revenue goes toward patient care, moved to the full House for consideration after a 42 to 0 vote.
Price transparency legislation advances
Legislation that aims to expand healthcare price transparency requirements advanced to the full House Wednesday. The House Ways and Means Committee voted to move the bill forward on a party line vote of 25 to 15.
The Health Care Price Certainty for All Americans Act would mandate that hospitals, imaging providers, ambulatory surgical centers and labs provide pricing information for employers and patients. Insurers would also have to publish their negotiated prices, as well as in-network and out-of-network rates, and give patients a cost estimate before they receive services.
The bill would jumpstart competition between providers and increase penalties on large healthcare firms that don’t publicly share price information, Rep. Jason Smith, R-Mo., said during a markup on a raft of legislation Wednesday. Price transparency has been a priority of the Trump administration since its first term.
But Democrats pushed back on the bill. Rep. Gwen Moore, D-Wis., argued that forcing patients to sift through pages of pricing data won’t help them better understand the cost of their care. Plus, the legislation won’t ameliorate the damage for other GOP healthcare policies that will likely remove people from coverage, she said.
“Americans don’t need more paperwork, they need healthcare that they can afford,” Moore said Wednesday, on behalf of Rep. Richard Neal, D-Mass., who was absent.
Bill aims to boost healthcare workforce
Sens. Tim Kaine, D-Va., and Lisa Murkowski, R-Alaska, introduced a bill Thursday that aims to limit the impact of employee shortages in healthcare by helping international graduates enter the workforce. Companion legislation was also introduced in the House.
More than 2 million college-educated immigrants in the U.S. are unemployed or underemployed, and about 270,000 have health-related degrees, according to data from the Migration Policy Institute cited by the lawmakers.
The Welcome Back to the Health Care Workforce Act would support partnerships between healthcare organizations, community groups, higher education, and state and local governments to connect international graduates with resources to get started in the healthcare industry.
The legislation comes as the nation is facing a healthcare worker shortage as the population ages and needs more care, especially in rural areas. Some foreign healthcare workers could also lose their work permits amid the Trump administration’s immigration crackdown.
“These health care professionals have found a home in Alaska and are ready and willing to answer the call to serve their communities,” Murkowski said in a statement. “It is a win for everyone when we recognize their value and welcome their expertise into our nation’s health care workforce.”
