Trump health plan called ‘pixie dust’ on pre-existing conditions, builds on transparency bid

By | September 26, 2020

Dive Brief:

  • President Donald Trump’s “America First Healthcare Plan” unveiled Thursday at a North Carolina rally largely touted administrative efforts already in the works rather than new initiatives and those that require further action to move forward.
  • Trump signed two executive orders: one to end surprise billing and another to protect patients with pre-existing conditions. The first states if Congress is unable to enact its own legislation by Dec. 31, the secretary of HHS will take administrative action to prevent patients from receiving surprise bills. The second states it is the official policy of the United States government to protect patients with pre-existing conditions.
  • Price transparency was another key talking point with some new stipulations in the plan. Under the order, CMS’ Hospital Compare website, used to inform beneficiaries about their options for receiving care, will state whether a hospital is in compliance with the final price transparency rule after its implementation Jan. 1.

Dive Insight:

The efforts on pre-existing conditions come as the fate of the Affordable Care Act, which provides such protections, hangs in the balance. A key case is set to be heard before the Supreme Court just a week after election day.

That element of the ACA has been among the most popular.

Experts said both executive orders will have little practical effect without action from Congress. Larry Levitt, executive vice president of the Kaiser Family Foundation called it “pixie dust” among other descriptors.

Critics also noted and the administration in fact touts in the order, that it has pushed short-term plans that don’t require coverage for pre-existing conditions and in fact rarely do.

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The administration’s push for price transparency has not been well received by the industry — especially hospitals. The American Hospital Association sued HHS in December when it implemented the final rule mandating they reveal secret rates negotiated with insurers.

A judge ruled in favor of HHS and the price transparency rule in June, and AHA appealed several days later.

Thursday’s order includes other actions targeted toward consumer choice, including more changes to CMS’ Hospital Compare site.

Slated to go in effect within 180 days, not only will the site list a hospital’s compliance with the price transparency rule, but also whether it provides patients with itemized receipts, and how often a hospital pursues legal action against patients.

Surprise billing is another important issue among both voters and legislators addressed in the plan, despite multiple attempts from Congress to pass legislation banning it. Surprise bills most often occur when someone receives a bill from an out-of-network provider at an in-network facility.

Hospitals and payers have been squabbling over how out-of-network payment should be determined — a hangup that’s impeded progress.

Providers prefer that a ban on surprise billing use an arbitration process to determine rates, while payers want there to be set rates for out-of-network services, such as 125% of the Medicare rate.

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