The Business of Health

As the divided 118th Congress opens today, here are the hot-button health issues we’re watching:

• Prescription Drug Costs: Next to health insurance premiums, prescription drug costs are the metric by which Americans measure affordability of care. These costs have continued to increase at an unsustainable rate.
  
  Republicans will likely:

  • Seek repeal of the Inflation Reduction Act provisions related to drug pricing controls and inflation rebates, which largely impact Medicare beneficiaries.

  • Find a pathway to cap out-of-pocket costs of insulin for those covered under private insurance.

• Health Care Coverage Affordability: Supply chain delays coupled with general inflation compounded systemic health care cost increases, shouldered by both the federal government and households.
  
  Republicans will likely:

  • Pursue rollbacks of the ACA, including: consumer protections, premium tax credit eligibility, open enrollment opportunities and the “family glitch” solution.

  • Reinstate the ability for narrow, short-term (and lower cost) “junk plans” to be offered in the marketplace and expand the use and terms for high-deductible health plans (HDHPs) and health savings accounts (HSAs).

  • Raise the eligibility age for Medicare and increase opportunities for privatization of the program.

• Telehealth Access: Flexibilities in payment policy and investments in broadband in COVID relief packages advanced decades of efforts by telehealth advocates.
  
  Republicans will likely:

  • Advance pieces of larger legislative packages, such as the CONNECT for Health Act, focused on telehealth expansions initially made possible through Covid relief packages.

We’re also watching how Congress tackles other health issues in the headlines: 

• Reproductive Health: It is unlikely federal legislation will advance but policymakers on both sides will continue this debate.
  
  Republicans will likely:

  • Reintroduce legislation at the federal level to ban all abortion care and services with very narrow exceptions.

  • Reduce funding and increase restrictions on federal family planning programs, such as Title X and the United Nations Population Fund (UNFPA).

  • Create stricter guidelines for coverage of abortion services under Medicaid.

  • Reverse requirements for coverage of family planning services, including birth control, in private insurance health plans.

• Mental and Behavioral Health: Covid has only further exacerbated this public health crisis.
  
  Republicans will likely:

  • Base next steps on negotiated bipartisan Committee-level proposals, focusing primarily on children and opioids, with policy facing constraints on any new funding.

  • Focus on health care workforce shortages in this area and more broadly in health care. Workforce shortages were unable to meet demand for care pre-pandemic, and this has only worsened as need increases.

• COVID-19: Illness, health complications and deaths due to COVID-19 continue, and associated hospitalizations strain the public health and health care infrastructure.
  
  Republicans will likely:

  • Seek increased oversight and transparency of the federal pandemic response in general and the CDC specifically.

  • Apply pressure to limit the extension of the Public Health Emergency declaration (ending January 11, 2023), possibly urging an exception for Medicare telehealth coverage policies.

  • Address the growing pressures on the health care workforce, including increased workplace violence.

The Biden administration’s pro-labor regulatory agenda at the Department of Labor and the National Labor Relations Board will continue.

Expect the administration to finalize proposed Labor rules, such as the independent contractor rule, while moving forward on work to update Davis Bacon standards that govern wages for contractors.

NLRB will continue to take a pro-labor posture, with a Democratic board majority assured through 2024.

Watch for the administration to revisit the overtime regulation and seek other ways to bolster workers in light of the Protecting the Right to Organize Act’s difficult path to passage.

Republicans will likely:

• Try to constrain DOL and NLRB through cuts to their budgets and extreme oversight, as well as pass budget riders to block DOL from finalizing proposed rules.

• Devote particular oversight to potential conflicts of interest at the NLRB, the NLRB’s General Counsel, DOL involvement in labor disputes and the White House Task Force on Worker Organizing and Empowerment.