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This Week in Health Care Reform: September 13th, 2019

Private equity firms’ deep-pocket push threatens to upend surprise medical billing legislation; administering specialty drugs outside of costly hospital settings would reduce costs by billions annually; meanwhile, the return of the HIT would increase health care costs by billions next year, alone; and, recognition of loneliness’ impact on overall health continues to grow.

Week in Review

Private Equity: Surprise medical bills continue to drive much of the revolving health care policy discussion.  And, it’s not a surprise, given how insidious the practice has become, affecting many patients, often when they’re at their most vulnerable.  What’s slowly come to light is the fact that surprise medical billing has become something of a deliberate business strategy employed by private equity firms, who in recent years have been largely responsible for driving market concentration amongst health care providers, gobbling up emergency medical and specialist practices.  Unsurprisingly, these firms are keen on protecting this profit center and have engaged in a deep pocket push to frustrate legislative efforts to protect consumers from surprise medical bills.  To accomplish this, they’ve successfully engineered to have an arbitration-style model included in proposed legislation.  However, there’s near universal agreement from everyone – apart from providers – that the inclusion of such a model would only increase health care price opacity, while adding unnecessarily burdensome administrative costs.  In fact, the Health Action Network attended a briefing on Capitol Hill last week in which experts representing stakeholders from across the health care spectrum, including economists, employers, consumer groups, and labor unions, were unified in their opposition to arbitration, instead, advocating on behalf of a median negotiated rate to better protect consumers from surprise medical bills.  (To see highlights from that event, check out #NoSurpriseBills on Twitter.)

Hospital Specialty Rx: Adding to the evolving conversation surrounding hospitals’ role in driving up health care costs, a new study came out this week pointing to the possible savings that would result from administering increasingly expensive specialty drugs outside of already costly hospital settings.  This class of medicines accounts for a large portion of our overall drug spending costs – and, it’s on the rise.  However, the study, released by UnitedHealth Group on Monday, estimates that changing the location of where these drugs are administered away from hospitals or hospital-owned physician practices and into doctors’ offices or even patients’ homes could result in savings of up to $37,000 per patient.

HIT Costs: According to the IRS, the reimplementation of the onerous health insurance tax (HIT) next year would levy a $15.5 billion tax bill on health insurers.  Created under the Affordable Care Act, the HIT was essentially designed to fund the health care law’s insurance exchange marketplaces by imposing a fee on insurance providers based on premiums and market share.  Unfortunately, it only ended up increasing health care costs for low- and middle-income families, small business owners, and seniors, amongst others.  With that in mind, lawmakers have suspended the HIT in past years, most recently for 2019.  But, absent Congressional action, the tax is slated to return next year.  Bipartisan efforts are underway, though, to extend the moratorium on the HIT through, at least, 2020.  However, with so much already on their health care agenda, it’s unclear when Congress will be able to take up the proposed bills

Health Impact of Loneliness:
As recognition of the role that social isolation plays in health outcomes has steadily increased, experts have acknowledged the need to identify and build “societal institutions that bring meaning and purpose” to individuals’ lives in order to better address these feelings.  With due deference to the emotional component of loneliness, stakeholders have also worked to shine a light on the ‘whole-person health’ aspect of the issue, raising awareness and encouraging an open dialogue in a concerted effort to remove the stigma that has too long attached itself to the issue of loneliness.      

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