PoliticoPro: Future of health care: Covid-19 briefing takeaways

June 5, 2020 4:59 pm

The coronavirus pandemic has upended all facets of American life, including the way Americans interact with the health care system. On the latest subscriber-only conference call on Thursday, Pro Health Care reporters took a step back to consider the future of health care after Covid-19.

Adriel Bettelheim, Dan Goldberg, Rachel Roubein and Susannah Luthi discussed whether the pandemic and the economic collapse it spawned will chip away at workplace insurance, how telehealth and primary care may be having their big moments and the measures states could take to address a flood of new Medicaid recipients, among other topics.

Here are the main takeaways:

End of workplace insurance? Not so fast.

More than 42 million Americans have applied for unemployment benefits since the nation first went into lockdown to prevent the spread of the coronavirus. You’d think this would be progressives’ big moment to uncouple health insurance from jobs, but so far we’re not seeing that. Employer insurance makes the industry far too much money to shrink without a fight, Susannah noted, and Congress has made it clear this isn’t the beginning of the end of job-based coverage. That said, the small employer market has been eroding for years, and the pandemic will certainly exacerbate that.

At the same time, the pandemic has squashed liberal governors’ ambitious plans to give more Americans government-backed health insurance in states such as Colorado and California. State subsidies for low-income residents to buy health care from an ACA-like exchange is a tough sell right now because state coffers have been hit so hard by the pandemic. And, Dan added, the prospect of taking on the powerful hospital industry to cap rates providers can charge amidst a pandemic that’s seen hospitals’ polling soar is politically fraught.

Expect some short-term changes to stay put.

In response to the surge in demand for health providers, the Trump administration has taken steps to bolster workforces. CMS, for instance, has allowed physician assistants and nurse practitioners to perform duties they previously could not. While those authorities tend to end once the public health crisis subsides, it gives groups momentum to press state legislators and Congress for permanent changes, Rachel noted.

The federal government has also temporarily lifted licensing restrictions on telehealth and restrictive payment policies that many believed were holding back the industry. The incentives are there to make those changes permanent, Susannah said. There’s a lot of pressure right now from provider groups and insurers to maintain the focus on telehealth, though how long that lasts may depend on how long the pandemic lingers on and how long people remain wary of visiting clinics and hospitals in-person.

The pandemic has also refocused attention on chronically underfunded primary care, whose proponents are pushing for more commitments from Congress to prevent furloughs and job cuts due to fewer in-person visits amid lockdowns. It’s worth looking at a year from now, Rachel said, to see if this could be primary care’s moment.

Momentum for surprise billing?

The White House has renewed a push to end “surprise” medical billing in a bid to protect insured patients from the sometimes-staggering costs of emergency and out-of-network care. The proposal being floated by the Trump administration would ban health care providers from putting patients on the hook for thousands of dollars in expenses — but it punts on a payment mechanism for settling billing disputes between providers and insurers, arguably the most contentious part, Rachel noted. The proposal appears designed to bring on board hospitals, which had been a powerful opponent of previous billing fixes, but so far, it doesn’t seem to be attracting much industry support, Susannah added. Doctors say it gives too much leverage to insurance companies, and insurance companies say that without a benchmark for resolving billing fights, there’s nothing to keep rates down. There are rumors of a Congressional Budget Office score that supports that, said Susannah.

Overall, the path forward for acting on surprise medical billing is unclear. Congress has tried to act in a bipartisan fashion for a year but has failed as health interests turned on each other amid a massive lobbying effort. And Democrats’ didn’t include anything on surprise billing in their latest coronavirus relief measure. Still, momentum for congressional action could increase, as we haven’t yet seen what surprise bills could come out of the coronavirus crisis.

How will states account for surging Medicaid rolls?

States facing plummeting tax revenue are announcing deep cuts to their Medicaid programs just as millions of newly jobless Americans are surging onto the rolls. Absent additional federal aid, Dan said, it will be difficult for states to balance their budgets and avoid further cuts. With negotiations underway between the House and Senate over the latest round of aid, it remains to be seen how much money will go to states — and how much latitude they’ll have to use that money as they see fit.

With revenue plunging, time for a debate on how we pay for health care?

Hospitals and doctors’ practices have seen revenues plunge as the pandemic has canceled lucrative elective surgeries and led many to delay in-person care. Congress has approved $175 billion to bail out struggling providers, but much of that money has gone to big hospital chains while independent practices keep flailing. Medicaid providers have received a disproportionately lower share of Covid-19 bailout money, prompting a bipartisan group of top House and Senate lawmakers to demand a timeline from the Trump administration for distributing the roughly $100 billion in funds that Congress earmarked for providers months ago.

Meanwhile, Rachel noted, some employer groups are pressing for an end to the fee-for-service model they say the public health crisis has shown isn’t resilient. While the effort remains nascent, it’s possible the pandemic could spur a public debate over long-term restructuring of the health system, Dan argued.