Overnight Health Care — Presented by Rare Access Action Project — Court ruling reignites ObamaCare fight for 2020 | Congress expands probe into surprise billing | Health industry racks up wins in year-end spending deal

Welcome to Thursday’s Overnight Health Care.

There is fresh uncertainty over the fate of ObamaCare after a Wednesday court ruling, and the decision is already ramping up the 2020 health care fight. The year-end spending bill was a big gift to the health industry, and Michael Bloomberg rolled out his health plan. 

We’ll start with the court ruling…



Court ruling reignites ObamaCare fight for 2020

ObamaCare was thrust back into the 2020 spotlight on Wednesday after a federal appeals court ruling added new uncertainty over the law’s future. 

In a 2-1 ruling, the 5th Circuit Court of Appeals found the individual mandate unconstitutional, but avoided ruling on the entire law, instead sending the case back down to the district court level.

The lawsuit, which is supported by the Trump administration and was filed last year by Republican attorneys general, seeks to dismantle ObamaCare, which has grown in popularity after Congress failed to repeal it two years ago.

Democrats used the ruling to revive their attacks on Republicans over health care — a strategy that helped them win back the House majority in 2018 and one they hope helps them take the White House in 2020. 

“The Republicans don’t have a plan. This is the party that has actively tried to take away my health care coverage for the last ten years,” said Rep. Lauren Underwood (D-Ill.), whose seat Republicans are trying to flip in 2020.


“I really don’t see where they go because the American people have already said decisively health care is their number one issue.”

Yes, but: The legal fight could also benefit Republicans if a final ruling is pushed until after the 2020 elections. California Attorney General Xavier Becerra (D), who is leading ObamaCare’s defense in court, has asked the Supreme Court to hear the case instead of it going back to the district court, but it’s not clear if that will happen. If it does, a final outcome could come sooner, potentially before the 2020 elections. 

Read more on the case and the 2020 fallout here


Congress expands investigation into surprise billing 

Legislation to stop surprise billing did not get passed by the end of the year, but that hasn’t stopped lawmakers from investigating the practice, and demanding answers from the parties involved– namely physician staffing firms and insurers. 

The top Democrats and Republicans on the House and Senate health care committees on Wednesday announced an expansion of their investigation into surprise billing. 

The lawmakers sent new letters to insurance companies, asking how they negotiate rates with physician staffing companies (that are sometimes backed by private equity) and how they protect patients from getting surprise bills. 

The letters went out to Anthem, Cigna, CVS Health, Health Care Service Corporation, Highmark and UnitedHealth Group. 

The lawmakers also sent letters to two physician staffing firms: Envision Healthcare and TeamHealth. 

The members launched their investigation into surprise medical bills in September with requests for information from private equity firms who are tied to physician staffing companies. 


Health industry racks up wins in year-end spending deal

Congress started the year with heady talk of bipartisan action to lower drug prices and protect patients from surprise medical bills. 


It ended the year with a massive government funding deal that did little to address those issues but did cut taxes on the health care industry by $373 billion. 

The result is a year-end government funding package that was a win for the health care industry and highlighted just how hard it is for lawmakers to overcome powerful industry groups.

Doctors and hospitals lobbied hard against the leading surprise medical billing solution, while the pharmaceutical industry lobbied hard against action on drug prices. 

Takeaway: “It says that the power of special interests is alive and well,” said Shawn Gremminger, senior director of federal relations at Families USA, a liberal health care advocacy group. “Even under new leadership in the House, it’s hard to overcome entrenched special interests.”

But be on the lookout next year: It is still possible that drug price and surprise billing legislation could be signed into law next year. Speaker Nancy Pelosi (D-Calif.) is pushing for a health care package ahead of a May 22 deadline for extending some expiring health programs like community health center funding. But action deep into an election year will be difficult.

Read more here



Bloomberg offers public option, subsidies in new health plan

Democratic presidential candidate Michael Bloomberg on Thursday introduced a health care plan that would create a “public option” operated by the federal government, as well as massive new subsidies to help people afford health plans on the Affordable Care Act exchanges.

The plan is much closer to the ideas of moderates like former Vice President Joe Biden and South Bend, Ind., Mayor Pete Buttigieg than those of Sens. Elizabeth Warren (D-Mass.) or Bernie Sanders (I-Vt.). It gives Americans the option of buying public insurance, but does not move the entire country into that system. 

Bloomberg’s plan makes it clear that he is in favor of more modest changes to the health system. During a call with reporters to unveil the plan, Bloomberg’s health care advisers said he did not envision his public option as the first step toward enacting Medicare for All.

“We’re not trying to rock the boat and get people off their insurance if they like it. We want to keep private insurance,” one of his advisers said. 

As for the cost, Bloomberg’s team doesn’t have a complete estimate yet. They told reporters a “loosey-goosey” estimate, based on similar proposals from think tanks, would cost about $1.5 trillion over 10 years, with $500 billion in savings. 

Read more on his plan here.



Senate Democrats slam HHS reversal of non-discrimination protections

Every Senate Democrat wants the Department of Health and Human Services to rescind a plan that would allow recipients of HHS grants and contracts to discriminate on the basis of religion and sex.

The entire caucus, led by Sens. Patty Murray (D-Wash.) and Ron Wyden (D-Ore.), signed onto the letter to HHS Secretary Alex Azar.

“It is unconscionable that HHS has disregarded essential nondiscrimination protections, chosen to no longer enforce them and has pursued a rollback of the very protections that ensure HHS funding benefits all people in an equitable way,” the Democrats wrote.

In November, the administration proposed a rule that would effectively end non-discrimination protections for LGBTQ individuals in HHS grant programs — most notably adoption and foster care centers but also programs like HIV prevention. The Trump administration has defended the move as part of its commitment to protect religious liberty. 

Supporters of the policy have argued that faith-based groups were forced to compromise their religion if they wanted to participate in a federally funded adoption and foster care program. 

Read more here.


What we’re reading

ObamaCare ruling may spare Republicans some political pain (New York Times)

3 legal experts on what the ObamaCare ruling really means (New York Times)

Seeking fresh momentum, Warren recalibrates ‘Medicare for All’ rhetoric (Reuters)

Border fight: Trump’s plan to import cheaper drugs from Canada faces hurdles (Kaiser Health News)


State by state

California attempts to revive compassionate cannabis programs (California Health Line)

The abortion war goes local as ACLU lawsuit seeks to thwart Tennessee town’s ban (Washington Post)

New Hampshire to receive Medicaid grant for pregnant mothers struggling with opioids (New Hampshire Public Radio)  


From The Hill’s opinion page

‘Medicare for All’ ignores a bigger problem

Here’s how to reduce drug costs 

2019 was a historic year for marijuana law reform, here’s why

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