When Americans voted in the 2018 midterm election, healthcare was a hot issue. Consider the fact that in a PwC Health Research Institute Consumer Survey in September 2018, 59% of the 1,500 respondents cited healthcare as the most important issue. So now that the Democrats will control the House and Republicans will have a greater majority in the Senate, will they attempt to address the healthcare issues Americans are complaining about?
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Congress will start with a clean slate in January. “Many bill sponsors and co-sponsors from the 115th Congress are no longer Congressional members,” says Annette Bechtold, senior vice president of Regulatory Affairs and Reform Initiatives at OneDigital, which provides employers with benefit advisory services. “All old bills that were introduced will be dismissed and all previously proposed legislation will need to be reintroduced. Educating new members while finding new sponsors and co-sponsors will add to the lengthy timeline of getting things accomplished.”
Here’s how experts predict healthcare will unfold in 2019.
1. There could be more changes to the ACA
The Democrats’ midterm wins will likely slow, but not stop, the Republicans’ pursuit of their healthcare agenda—which has focused on deemphasizing the role of the federal government in the U.S. health system, says Benjamin Isgur, health research institute leader, PwC, which analyzes trends affecting health-related industries.
Democratic control of the House likely means that Republican lawmakers will not undertake another attempt for wholesale repeal and replace of the ACA. Rather, the most substantive action related to the ACA will happen as the result of regulation and executive action. Without overwhelming majorities that can grant veto power, however, Democratic lawmakers will have little room to pursue their own agenda without bipartisan support.
But Michael Strazzella, co-head, Washington office and group practice leader of federal government relations at the law firm Buchanan, Ingersoll, & Rooney, PC, believes the Senate, having grown its majority, will make efforts to repeal the ACA as it did in the 115th Congress. “Unlike the last Congress, however, I expect them to ensure that pre-existing conditions are protected in order to ensure that the issue can be avoided during the 2020 elections,” he says. “The House will hold hearings to highlight pieces of the ACA that they consider to be successful. Moreover, they will attempt to further block executive branch efforts to impede implementation of the ACA.”
2. The Trump administration will continue to use regulatory agencies in an attempt to transform Medicaid, roll back industry regulations, and address drug pricing
These changes can be made without congressional input. HHS will move full speed ahead with initiating block grant pilots and enabling states to reduce their Medicaid programs through premium and work requirements, reducing benefits, and raising income thresholds, in order to create savings for poorer states and reduce the federal match to help fund tax reductions, says Gerry Hinkley, JD, leader of the healthcare industry team at Pillsbury Law, which provides legal services that support the healthcare industry. HHS will also continue the “reducing reporting burden” approach carried forward in the 2019 Inpatient Prospective Payment System rule as a basis for accelerating the reduction in Medicare support for inpatient care.
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Regarding drug pricing, the recently-enacted Know the Lowest Price Act and Patient Right to Know Drug Prices Act will improve transparency of drug pricing for patients. “I expect the president to continue to pressure pharmaceutical manufacturers to reduce drug prices, but it’s not clear when or whether further action will be taken by regulatory agencies,” says Eric D. Fader, JD, partner in the law firm Rivkin Radler LLP.