Hospitals, Heart Association Outline Reconciliation Priorities

Inside Health Policy

September 3, 2021 11:31 am

As Congress’s self-imposed Sept. 15 deadline to ready a massive reconciliation package approaches, several health care stakeholders, including hospital associations and the American Heart Association, have sent priority lists to Congressional leadership, and lobbyists expect more to come next week. Sources have also heard that the House Ways & Means committee will mark up its piece of the bill on Sept. 9 and Energy & Commerce will do the same on Sep. 13, however, one source says the dates are placeholders and neither committee could confirm by press time.

Sources also see the Sept. 15 deadline included in the budget resolution as relatively soft, and would not be surprised to see the final language or a vote held until later this year. In addition to writing the specific language, Democratic leadership must also nail down the cost of the bill, which has a $3.5 trillion limit on paper. Several moderates, including West Virginia Democratic Sen. Joe Manchin, have already made clear they will not support that much spending, and final number could fall into the $2 trillion range, say sources tracking the talks

Already, Democratic staff have said conceded that the $400 billion investment in home-and-community based care will fall to $250 billion. Staff are also working to find a less expensive way to include dental, vision and hearing coverage in Medicare — which could mean a later start date for the benefits. The package is also expected to include an extension of the increased Affordable Care Act tax credits enacted under the American Rescue Plan, but how long is unclear. It will likely also include a mechanism for closing the Medicaid gap, either by extending subsidies to the population that earns less than 100% of poverty, creating a federally backed Medicaid program, or a combination of the two. Health care stakeholders are also pushing for Medicaid policy changes like increased post-partum coverage, allowing continuous enrollment in Medicaid and more. Additionally, stakeholders say Congress should use the opportunity to support the health care workforce and lay the groundwork for better pandemic preparedness. Stakeholders also want lawmakers to tackle prescription drug costs. The hospitals further urge Congress to avoid taking money from their industry.

In its letter, the American Heart Association stressed the need to maintain the increased ACA tax credits beyond the 2022 end date to prevent consumers from facing sudden price increases. The lobby says the policy — which increased credits for existing consumers and extends them to people earning more than 400% of poverty — should be made permanent. The American Heart Association also asks Congress to fix the glitch that blocks families from accessing subsidies if a worker is offered a plan that is affordable, even though the affordability threshold is based on self-only coverage.

The lobby calls on lawmakers to encourage all states to expand Medicaid by providing 100% federal funding for the first three years for any states that choose to expand. The American Heart Association strongly supports expanding Medicare to include dental, vision and hearing, saying it is a critical step to achieving health care equity. “Oral health care is a key determinant of economic stability, continued employment opportunities, improved social connectedness, and overall health and wellness,” the group writes. The lobby also urges Congress to tackle the high costs of prescription drugs.

The American Hospital Association also wants the ACA tax credits extended and for health care to be provided for everyone in the non-Medicaid expansion states. AHA does not specifically ask Congress to extend ACA subsides to that population, rather than create a federal Medicaid program, which the Federation of American Hospitals does. AHA’s letter also avoids any mention of extending Medicare benefits.

AHA also sidesteps any talk of allowing Medicare to negotiate prescription drug prices, but stresses that the drug costs are a major concern as they disrupt care and strain hospital budgets. “The AHA is committed to working for action on policies that foster transparency, competition and value while preserving innovation,” they lobby writes.

AHA further calls for temporary relief for any 340B hospital that had to leave the program due to changes in patient mix caused by the pandemic.

AHA calls on Congress to prioritize cybersecurity and telehealth, encourage delivery system reforms, secure the health care supply chain and help prepare for future crisis.

Finally, the hospitals say that “as Congress looks for offsets for important reconciliation policies, the AHA urges Congress to avoid consideration of any provider reimbursement cuts that would further strain financial resources for hospitals and health systems.”

“America’s hospitals and health systems are providing essential services to their patients and communities during this pandemic, all while facing their greatest financial crisis,” AHA says. “COVID-19-related expenses are skyrocketing, including for personal protective equipment, pharmaceuticals and safety equipment, maintaining testing and additional screening for every hospital patient.”

Staffing shortages are also acute which is driving up costs, AHA says.

America’s Essential Hospitals, which represents the country’s safety-net hospitals, includes help for staffing shortages as a top legislative priority. In the letter to Congress that includes its wish list for the reconciliation package and other vehicles moving this fall, the lobby asks lawmakers to consider emergency funding to support the essential workforce.

The hospitals also support measures to lower drug pricing, but they urge Congress to consider how any changes would affect the 340B program.

“Drug pricing reform must recognize potential ramifications on existing safety net supports for essential hospitals,” the group says.

“Lawmakers must consider how proposed drug pricing policies would interact with the 340B program and ensure those policies would not undermine the benefit of this critical lifeline, especially as essential hospitals continue to respond to the challenges presented by COVID-19. We ask Congress to reject policies that would require Medicaid managed care plans to pay for outpatient drugs at actual acquisition cost. Such a policy would drastically reduce 340B savings for some providers in the program. If, however, drug pricing reforms ultimately do reduce the value of the 340B savings to essential hospitals, it will be critical to issue another form of funding to ensure our members can continue to innovate and respond to the unique care challenges and needs of marginalized populations,” it adds.

The lobby also urges Congress to include in any legislative vehicle a technical fix that ensures the new definition of Medicaid shortfall does not disadvantage safety net hospitals.