House v. Burwell

Electron microscope view of the Zika virus.

In HealthAffairs, Timothy Jost looks at  the healthcare elements of President Obama’s proposed budget for 2017, which includes “new initiatives to increase access to mental-health care, expand opioid-abuse treatment, fight antibiotic resistance, address the Zika virus threat and fund a ‘cancer moonshot.”’

He writes: “To control Medicare spending, the budget proposal would reduce the target growth rate for Medicare enforced by the Independent Payment Advisory Board  {IPAB} to 0.5 percentage points above per-capita GDP growth. It also contains a host of Medicare payment and delivery reform proposals.”

Regarding private insurance, one proposal “would attempt to curb surprise balance bills by out-of-network providers by requiring hospitals to take steps to match patients with in-network providers and requiring physicians who regularly provide services in a hospital to accept an appropriate in-network rate as payment in full.

“Another proposal would allow HHS {Department of Health and Human Services} to develop uniform definitions and principles for standardizing medical billing and making it more transparent. Self-insured non-federal governmental plans would be prohibited from opting out of various federal consumer protection laws, such as the Mental Health Parity Law.”

Mr. Jost notes that “{T} budget request of a president in his final year of office ….is unlikely to lead to enacted legislation. Congress in unlikely to expand the authority of the IPAB or increase funding for the Medicaid expansions. But many of the expenditures identified in the budget—for the risk adjustment, reinsurance, premium tax credit, and (subject to the court decision in House v. Burwell) cost-sharing reduction payment programs—are mandated by law and are unlikely to be changed by Congress.”