When you or any other normal person thinks of summer, images of cookouts, fireworks and fun by the pool probably spring to mind.
For nerds like me, summer the year before a presidential election is for vigorous policy debate! Apart from immigration, health care has been the primary focus for federal and state lawmakers.
Policymakers are working to solve a number of health care issues big and small. Action in the political space has range from committee hearings on the theoretical (e.g. Medicare-for-All) to food fights on very narrow policy changes (e.g. requiring drug makers to list the price of drugs in their commercials). Both Republicans and Democrats are racing to put their stamp on health care policy. Depending on your worldview, all of this focus could be to make life better for all of us patients or to score points before election season next year.
Either way, it’s a lot to keep track of so I thought I’d highlight below a brief summary of the policies and activities that we’ve been focused on in GR. If you have any questions or want to debate the merits of Medicare-for-All please reach out!
What We’re Watching and What We’re Doing
- Surprise Billing – Congress continues to debate the best pathway to protect patients from “surprise bills”. A surprise medical bill is a term used to describe charges arising when an insured individual inadvertently receives care from an out-of-network provider. One option being considered is to use third-party arbiters to negotiate disputes between providers and health plans. URAC is working with the National Association of Independent Review Organizations (NAIRO) to promote the role of accredited IROs on Capitol Hill. Read our joint policy statement here.
- State Medicaid Innovation: States continue the laboratory for innovation in health care as many test new ideas to deliver better care at lower costs to Medicaid enrollees. We’re focused on ensuring that quality remains high and patients are protected. Most recently, Texas recently enacted a law that would require their Medicaid health plans to become accredited by 2022. Read the press release here.
- PBMs Face Scrutiny: Congress and state policymakers have increased their scrutiny of Pharmacy Benefit Managers (PBMs). In fact, several states have already enacted legislation to increase their oversight of PBM operations. Same states are considering legislation that would restrict a PBMs ability to utilize accreditation as a quality tool. We’re working hard to fight back against these provisions as we know pharmacy accreditation is an important tool to protect patients. But it’s not all bad, most states that have chosen to enact PBM oversight legislation does not mention accreditation and one even promoted accreditation!
*If you’re interested in tracking what we’re working on, Brittany runs a pretty great blog for us! You can follow it here.
