A surprising bipartisan effort to improve health coverage
Rep. Diane Black, a Tennessee Republican congresswoman, and Earl Blumenauer, a Democratic congressman from Oregon, don’t agree on very much about health care.
Both sit on the powerful House Ways and Means Health Subcommittee and both tend to vote on the opposite side of most health care issues. Black, a nurse by training, has called President Barack Obama’s Affordable Care Act an “abject failure,” which she argues was “built on a grand deception.”
Black’s dislike of liberal health care policies is well known. She’s best known on Capitol Hill for her hardline anti-abortion stance. Earlier this year, she authored the Conscience Protection Act, a bill, approved by the House 245-182 preventing discriminating against a health care provider based on the provider’s refusal to be involved in or provide coverage for abortion. Black is also well known for her role as a member of the controversial Select Investigative Panel on Infant Lives, a House committee formed in the wake of last summer’s Planned Parenthood sting videos.
Blumenauer, on the other hand, is an environmental crusader who is known for cycling from his Washington residence to the U.S. Capitol and occasionally to the White House for meetings. A strong supporter of the President’s Affordable Care Act, Blumenauer says “it is absolutely a step in the right direction,” and has strongly criticized Republicans’ efforts to dismantle the health care law as “a disappointing political stunt.”
His biggest accomplishment since winning the Portland, Oregon, district in 1996 has been getting Congress to approve giving veterans the right to discuss medical marijuana as a treatment option with the Veterans Affairs doctors in states where it is legal. He tried repeatedly to persuade Medicare to reimburse doctors for talking with seniors about their wishes for end-of-life care – and during the 2009 Obama health care fight, it was his amendment that then-Republican-vice-presidential candidate Sarah Palin labeled “death panels,” killing the amendment. But earlier this year, Congress finally passed a version of the legislation.
So getting Black and Blumenauer to agree on anything related to health care is noticeable. They’ve gone much further than that, co-sponsoring the Access to Better Care Act, which would change the tax code to increase access to chronic disease treatment by allowing what can be covered under high-deductible health plans before people have met their deductible. This would only apply to people with health savings plans.
Chronic conditions are particularly costly and hard to cover. Currently, Treasury Department regulations provide certain types of preventive care to be covered for free or at a reduced cost before the deductible is met. But that exemption does not apply to “any service or benefit intended to treat an existing illness, injury or condition.”
That means lots of people who are in high-deductible policies and have expensive chronic diseases, like heart disease or diabetes, have to pay the full cost to manage their conditions – and of course could also be exposed to unaffordable out of pocket costs. The bipartisan legislation would change that, allowing coverage of exams, prescription drugs and other services for people who have chronic conditions and are enrolled in high-deductible health plans.
The lawmakers and advocates across a wide spectrum of the health care world are hopeful this proposal will ease growing consumer anxiety over higher medical deductibles. One of the biggest criticisms of high-deductible plans is that instead of pushing people to be careful, cost-conscious health care consumers, these plans force people to avoid care altogether. Instead, this inches toward the idea of a value-based policy.
An increasing number of employers are pushing their employees into high-deductible plans and by far, they are the most common in the ACA’s individual and small group markets, because they cost the consumer less out of pocket. But for anyone with a chronic illness, these plans can become a financial nightmare.
America’s Health Insurance Plans, the insurance industry trade group, says almost 20 million people had a high-deductible health plan paired with an HSA (health savings account) in 2015, a 13 percent increase from 2014. HSAs were built into Medicare in the legislation that expanded prescription drug coverage under former President George W. Bush in 2003.
Not only are Black and Blumenauer working together, but in an election year in which Congress rarely accomplishes much, the bill has added fuel behind it with strong support from an unusual coalition of traditional political adversaries. The American Heart Association, the liberal consumer group Families USA, and pharmaceutical giants like Pfizer and Merck & Co. are among groups that have endorsed the bill. Even AHIP and the Blue Cross and Blue Shield Association, which represent the largest health insurance companies in the country, have also praised the Black-Blumenauer proposal.
“Given that 86 cents of every health care dollar is used to treat chronic conditions, it makes sense to remove barriers that make it harder for health plans to cover clinically proven services that help manage chronic conditions and improve quality of life,” argued the American Benefits Council President James A. Klein, adding his group’s support of the legislation. “We need more common sense bills like this one,” he said.
The bill has a more promising chance of becoming law because it represents one of the rare areas where common ground can be found on any health care legislation. “Many families don’t have the financial reserves to cover the full cost of a high-deductible health plan,” Lydia Mitts, a senior policy analyst at Families USA told Modern Healthcare recently. “We want to make sure all types of coverage are being able to do more to help people with chronic conditions.”
But Mitts was quick to add that her liberal-leaning organization is still “not a fan” of health savings accounts, a favorite of conservatives in Congress, because they “do not provide adequate protection for many families. HSAs often are more beneficial for wealthier people and families who have more disposable income so they can take the tax advantages. Older, sicker and lower-income people usually have less money to set aside for an HSA.
What remains unclear about the proposed legislation is how much it will cost, since the Congressional Budget Office has not yet reported its score for the bill yet. That will play a big factor in determining it’s legislative success. But the positive buzz the legislation is receiving on Capitol Hill is expected to get similar legislation moving in the U.S. Senate as chronic conditions are driving long-term health costs.
Also contributing to this story were Kaiser Health News, Business Insurance.com and Modern Healthcare.com