Impactful legislation is already in play with the interoperability and transparency initiatives.

A client asked me last week what the Biden Administration’s agenda for the healthcare industry was – and what kind of healthcare legislation we think is going to make the biggest impact over the next few years.

As Biden celebrates his 99th day in office this week with a joint address to Congress, it’s a good time to reflect on these questions. And they are two different questions – what Biden’s plans are, and what legislation will be most significant to the industry – with two very different answers.

First, we already have a good sense of what Biden and the Democratic Congress are going to tackle over the next few years, because of what has been rolled out as part of Biden’s Build Back Better plan. For a quick review, the Build Back Better plan has three parts:

The American Rescue Plan, the American Jobs Plan, and the American Family Plan.  

The American Rescue Plan was passed in early March; you’ll remember it was mostly a COVID relief package. The biggest healthcare provision in it – apart from the pandemic-related provisions – was the requirement that employers subsidize healthcare premium payments made through the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) for employees who were laid off. It also expanded subsidies for individuals and families on the Patient Protection and Affordable Care Act (PPACA) exchange.

The second element of Biden’s agenda, the American Jobs Plan, otherwise known as the infrastructure bill, was announced late in March; committees in Congress are currently drafting various elements of the legislation. While it’s still being formulated, the primary healthcare element in the legislation is a planned $400 billion to support home and community-based care for the elderly and disabled, mostly in the way of improving wages of home health workers.

The third part of Build Back Better is the American Family Plan, which will likely be rolled out this week to coincide with Biden’s address to Congress on Wednesday. Reportedly, the only healthcare elements in the American Family Plan would be a further extension of subsidies for the PPACA exchange.

Originally, there was a plan to target prescription drug prices in the package, but the Biden Administration has apparently dropped that. Progressives are also pushing to include an expansion of Medicare in terms of the eligibility age, and by including dental and vision benefits, but so far the Administration has not taken the bait.

Drafting and working to pass the American Jobs and American Family plans will keep the Administration and Congress busy for the next couple of years, so to answer my client’s first question, it appears that there is nothing on the Biden Administration’s and Congress’s short-term agenda that would have a significant impact on the business of healthcare today.

However, as we’ve said before, highly impactful legislation is already in play with the interoperability and transparency initiatives.

By transparency initiative, I mean not only the hospital pricing and the health plan transparency in coverage rules passed under the Trump Administration, but also the less-known transparency requirements in the No Surprises Act, including the requirement that providers – hospitals, physician groups, and independent providers, in and out of network – all must send a good-faith estimate of charges to a patient’s health insurance for all (I repeat, all) scheduled healthcare appointments.

Those two initiatives, interoperability and transparency – initiated during the Obama Administration and accelerated under Trump – will not only be the most burdensome for providers and health insurers to implement, they will also be the most impactful, giving consumers more access to their clinical and pricing information than ever before, and impacting contract negotiations, pricing strategies, and competition among hospitals and health plans for years to come.

Programming Note: Listen to Matthew Albright every Monday at 10 a.m. Eastern to hear the Monitor Mondays Legislative Update sponsored by Zelis.

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