Health Care: Beyond Opioids, Are Bipartisan Reforms Possible?

August 29, 2018

When Congress returns in September, the Senate passing opioid-related legislation and reconciling it with the House bill that was passed in June will be a priority.

It is unclear whether the Senate will have time, the votes, or the political inclination to take up any House-passed health care bills before the November election.  The House may consider some action on the ACA’s Cadillac tax, but the Senate will be focused on confirming judges, including a new member of the Supreme Court, and pushing through appropriations bills to keep the government running until the end of the year.  What, if anything, happens in the lame duck session in December largely depends on the outcome of the November elections.

Are bipartisan reforms possible?  Although the House has passed three HR Policy-supported bills that would improve health savings accounts, further delay the tax on fully-insured health plans, and permanently repeal the tax on medical devices on a solidly bipartisan basis, it is far from certain that Congress will get any of these bills to the President’s desk this year.

  • Should Congress fail to act on the Cadillac tax this year despite broad support in both chambers, the Association and our partners in the business community plan an aggressive effort next year to repeal or delay the tax.

Democrats will build case for single-payer:  Sen. Bernie Sanders' (I-VT) “Medicare for All Act” (S.1804) and its House companion bill (H.R. 676) currently have 16 and 123 cosponsors respectively, including several potential presidential candidates.

  • Other Democratic priorities: Although Sen. Sanders acknowledges his bill is unlikely to pass with the GOP in control of Congress, should Democrats regain control the House next year, they will press for a public option in every state, lowering Medicare and/or Medicaid eligibility to 55, and lowering the cost of prescription drugs.

Regulatory reform efforts:  The Trump administration is expected to continue its regulatory reform activities to give states more flexibility and control.

  • Expanding the state waiver program under the ACA could have serious implications for multi-state employer plans and will be closely monitored.

  • HRAs may get boost: The Trump administration is also expected to propose regulations or revise guidance to increase the usability of Health Reimbursement Arrangements.

EEOC wellness program incentive rules remain in limbo:  In 2017, U.S. District Judge John Bates struck down the Equal Employment Opportunity Commission’s (EEOC) final rules effective January 1, 2019.  While the EEOC will not be able to propose and finalize new rules before 2020, the Commission will likely use its enforcement discretion to effectively continue using the struck-down rules until new regulations are finalized.