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Opinion

Editorial: Is 2020 the year we’ll finally get some movement on healthcare reform?

healthcare
Proposals to protect consumers against surprise bills for emergency care and to slow the rising cost of prescription drugs won bipartisan support in Congress in 2019, but remain stalled by political and policy fights.
(Los Angeles Times)

The fights over healthcare policy this year — particularly the continuing legal battles over the 2010 Affordable Care Act — might lead you to believe that Republican and Democratic leaders were locked in a steel cage match over the future of American medicine. But even as these conflicts dominated the headlines, lawmakers and President Trump moved quietly closer to agreement on important consumer protections against surprise medical bills and excessive price hikes for prescription drugs.

The only question is whether they have the will to overcome the non-trivial hurdles thrown up by industry and their own parties.

Bipartisan proposals to end surprise medical bills emerged in the House and Senate in 2019, promising to protect consumers when out-of-network providers perform emergency treatment or appear unexpectedly at their hospital bedsides. Everyone agrees that consumers should not have to pay more than what their insurance plan requires them to pay for in-network emergency or hospital care. The problem has been coming up with a way to resolve disputes between what an out-of-network anesthesiologist or emergency room doctor charges for the services performed and what an insurer wants to pay.

Top Republicans and Democrats on the House and Senate health committees hammered out a compromise early this month only to have it come under attack from a slew of industry groups representing physicians, hospitals and air ambulance services, which argue that it would give insurers an unfair advantage over them. Whatever Congress decides, there will be winners and losers. But if it doesn’t act, the losers will continue to be consumers, and far too many of them: According to White House estimates, 20% of hospital patients admitted through the ER are hit with surprise bills. Congress must fix this.

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Separately, House Democrats passed an ambitious bill in 2019 to limit prescription drug prices by capping annual price hikes and empowering the Medicare program to negotiate with drugmakers over the cost of popular brand-name medicines. Although Republicans and Trump have supported versions of one or both proposals, the White House denounced the Democrats’ bill as a threat to lifesaving innovation. The administration is right that there’s a potential trade-off here, but it was an oddly harsh assessment coming from a president who’d supported a similar approach to controlling Medicare drug costs in the past — that is, until his zeal for lower prices faded in the heat of industry opposition.

A bipartisan Senate proposal to address escalating drug prices would take a much more measured step, protecting Medicare (along with its enrollees and taxpayers) against price increases greater than the rate of inflation for many of the medications it covers. Other provisions would help seniors with their out-of-pocket costs for drugs, but those mainly chip away at the edges of the affordability problem. There are no dramatic wins for consumers in the Senate bill, but the measure would at least take some of the sting out of the current system.

Nevertheless, even the Senate proposal is too much for some Republicans, who object to any form of price controls, and far too little for some Democrats. And more fundamentally, it’s stuck in a chamber whose GOP leadership wants to do little beyond confirming Trump’s judicial nominees.

The glimmer of hope for consumers is that everyone in Washington is eager to be able to say they accomplished something on healthcare costs. The various proposals on surprise bills and prescription drugs have laid out ample common ground. Lawmakers and Trump just have to be willing to go there.

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