HealthCare Roundtable e-News – March 4, 2020

Update: Public Sector HealthCare Roundtable and CalPERS Representatives Advocate for Surprise Billing Fix in Washington

On Thursday, February 27th, the Public Sector HealthCare Roundtable along with senior staff from the California Public Employees Retirement System (CalPERS) participated in several key congressional meetings, including visits to the offices of U.S. House Speaker Nancy Pelosi, U.S. House Majority Leader Steny Hoyer, and U.S. Senate Committee on Health, Education, Labor & Pensions Committee staff, to advocate for a federal solution to address surprise medical billing. The visit also included CalPERS’ participation in a briefing hosted by the Coalition Against Surprise Medical Billing, of which the Roundtable is a member. The briefing included over 50 attendees, including bipartisan Capitol Hill staff, allied stakeholders, and members of the media. 

The Public Sector HealthCare Roundtable supports a federal solution to the issue of surprise medical billing that includes linking out-of-network reimbursement to the median in-network rate. Most recently, the Roundtable joined a letter to the Chairman and Ranking Member of the House Committee on Ways & Means advocating for this approach that was signed by a range of health care purchasers. The letter can be viewed HERE.

For more information about Roundtable policy and advocacy activities, please contact Senior Policy Advisor, Andrew MacPherson, at

Coronavirus Outbreak Adds Urgency to Drug Pricing Debate

On Monday (March 2), President Trump met with several drug company representatives to discuss the status of vaccines and treatments for the 2019 novel coronavirus (COVID-19), and the House is expected to vote this week on supplemental funding for responding to the outbreak.

Several branded drug companies have recently begun work to develop a coronavirus vaccine(s), and the Trump Administration has pledged that treatments and vaccines resulting from private-public partnerships will be affordable to all Americans.

Four companies associated with the brand drug lobby PhRMA are working on vaccines and antivirals, including GlaxoSmithKline, Gilead Sciences, Johnson & Johnson and Sanofi Pasteur. Several other companies have donated money and medical supplies to efforts to stop the virus. (InsideHealthPolicy)

HHS Secretary Alex Azar testified in front of several congressional committees last week, and talking points on drug pricing evolved last week as he made his way through the four hearings on HHS’ proposed budget. On Wednesday, he criticized price controls and refused to promise that coronavirus drugs and vaccines would be affordable to everyone. The following day, he said coronavirus products developed in part with government funding would be affordable to all Americans. He also said the administration would back anything Congress can pass to lower drug prices, including Medicare price negotiation.

Supreme Court Will Hear Major Challenge to Obamacare

On Monday (March 2) The Supreme Court agreed to hear a third major challenge to the Affordable Care Act (ACA), setting up likely arguments this fall in a case that could wipe out the ACA all together.

The case was brought by a group of GOP-led states and is supported by the Trump Administration. The challengers in the case argue that the health law’s mandate for everyone to have coverage is now unconstitutional as a result of Congress repealing the financial penalty associated with it in the 2017 tax law, so the mandate can no longer be upheld under Congress’s power to tax. 

The case will be heard during the court’s next term, which starts in October, meaning that a decision is not expected until after the elections. It is unclear when the court will hear arguments, but those could come in October, prior to the election.

Trump Administration Open to Medicare Drug Price Negotiation, Says Azar

On Thursday (Feb. 27), Health and Human Services Secretary Alex Azar announced that the Trump Administration is open to “practical and implementable” policy on Medicare drug price negotiation. The question on drug price negotiation came up during a briefing with the House Ways and Means Committee on the agency’s 2021 budget proposal. (InsideHealthPolicy).

During his 2016 presidential campaign, President Trump had indicated his openness to pricing negotiation but has done little towards forwarding this policy since taking office. Other Republicans have also recently voiced their support for drug price negotiation legislation. Last week, Sen. Martha McSally (R-Ariz.) introduced a bill that would allow Medicare to directly negotiate the prices of medicines “that are past their original patent expiration but still maintain a monopoly for that drug.” The bill currently has no GOP co-sponsors, and Senate Finance Committee Chair Chuck Grassley (R-Iowa) has said that he will not include the Senator’s proposal in his updated drug pricing bill. (InsideHealthPolicy).

In contrast, Azar commented, “[Republicans] are probably the most flexible party in the room on drug pricing. If it gets list prices solved, if it gets out-of-pockets down for seniors and it gets the insurance companies to finally negotiate better against the drug companies we’re open to working bipartisan, bicameral with Congress to get that done,” Azar said. (InsideHealthPolicy).

Wicker Proposes Surprise Billing Draft with Air Ambulance Resolution

This past week, Senate Commerce Committee Chairman Roger Wicker (R-Miss.) circulated a proposal that would ban surprise medical bills associated with air ambulance services. The proposed bill would implement a dispute resolution process, as well as increases in the data reporting requirements for air ambulance providers and insurers. (InsideHealthPolicy)

Whether or not to include air ambulances services has been a controversial topic in the larger conversation around surprise billing legislation. Providers argue that these services should not be included in any legislation, and that instead the Department of Transportation’s air ambulance task force should determine a solution.

Wicker’s draft proposal would mandate that out-of-network emergency air ambulance providers cannot bill individuals for amounts exceeding the in-network rate while the independent dispute resolution is in process. The bill also includes time constraints on the arbitration process. Air Methods Executive Vice President Chris Myers expressed his support for the bill, stating that the fix, “creates an arbitration process that works to be fairly balanced between health insurance plans and medical providers and seeks to encourage both health plans and providers to continue to go in-network.” (InsideHealthPolicy)