Both the pace and scope of changes in the healthcare/health insurance space accelerated this past week (7/15/19-7/19/19) with several important developments.  Here’s a recap of what all took place…

  1. The 5th Circuit Court of Appeals heard opening arguments in yet another judicial challenge to the constitutionality of the Affordable Care Act (ACA), aka Obamacare.  Most observers expect this case, regardless of how the 5th circuit rules, to make its way to the Supreme Court of the United States, which would be the 3rd time the high court has been forced to decide whether the ACA stays or goes.  The latest challenge stems from a lawsuit filed by a group of attorneys general and two governors (Texas v. United States) addressing the elimination of the ACA’s individual mandate penalty by Congress as a part of the Tax Reform Act of 2018.
  2. The U.S. House of Representatives overwhelmingly passed the “Middle Class Health Benefits Tax Repeal Act”,  which seeks to repeal the ACA’s Cadillac Tax. Delayed twice and currently set to take effect in 2020, the Cadillac tax applies a 40% excise tax on health insurance  plans whose premium and spending account contributions exceed certain thresholds.   The matter now moves to the Senate, where a companion bill to eliminate the Cadillac tax awaits a vote.
  3. The House Energy and Commerce Committee approved legislation which seeks to mitigate out of pocket exposure associated with so called balance billing from non-contracted (or non-PPO) healthcare providers.  The “no surprise medical bill” has a ways to go though, as the Senate’s version of a similar bill does not match the House bill’s benchmarking pricing model, which establishes agreeable reimbursement levels for such care.
  4. The Treasury Department released guidance allowing Health Savings Account (HSA) qualified  high deductible health plans to provide benefits before the deductible is met, for services intended to treat certain, chronic conditions.  Under current guidelines, HSA qualified plans are only allowed to provide pre-deductible benefits for preventive care.  The notice specifies that in order to be covered prior to the deductible being met, services should be “low cost, and demonstrate a high impact”.  In addition, “there must be strong evidence that the absence of the service will result in the condition worsening or the development of another serious medical issue”.  Specific chronic medical conditions cited in the guidance include diabetes, asthma, depression, and heart failure.  It will now be up to insurers/payers to design HSA qualifed plans offered in 2020 that provide pre-deductible benefits that meet the new standard.

More to come!