Congress debates telehealth extension

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Oct 18, 2024 View in browser   By Ben Leonard and Chelsea Cirruzzo Presented by  Driving The Day Congress is debating whether to extend telehealth access in high-deductible health plans. | LM Otero/AP PRIVATE-PLAN TELEHEALTH QUESTIONS — Congress appears poised to extend eased access to telehealth for Medicare patients, but the fate of virtual care in high-deductible plans remains less certain as lawmakers plan for a year-end package. Tens of millions of Americans are on high-deductible health plans, which might have lower premiums, but out-of-pocket costs could be higher before patients hit their deductibles. The plans also come with health savings accounts with major tax advantages that can be used to cover health care expenses. Extension debate: Many Republicans and some Democrats have supported expanding what the plans cover more broadly, though other Democrats have cautioned the changes could undermine the Affordable Care Act by offering insufficient coverage. A March 2020 Covid-19 spending bill allowed high-deductible health plans to cover telehealth for patients before they reach their deductibles to help curb the virus’ spread. Congress allowed those provisions to lapse for the first few months of 2022 before restoring them, leading some patients to incur unexpected costs for virtual care. In late 2022, a narrowly Democratic-controlled Congress and White House extended the rules through the end of 2024, aligning their expiration with that of eased Medicare telehealth rules. But key Democrats are skeptical of continuing the telehealth rules for high-deductible plans, casting doubt about their fate. The telehealth industry and groups representing employers’ benefit interests are pushing for an extension in an end-of-year package. Rep. Richard Neal (D-Mass.), top Democrat on the Ways and Means Committee, has been wary of extending the telehealth provisions. Other Democrats joined him in voting against legislation from Rep. Michelle Steel (R-Calif.) that would make the high-deductible telehealth provisions permanent. Neal pointed to the cost and argued that Republicans have used the plans to undermine the ACA. The Congressional Budget Office estimated the legislation would cost about $5 billion over a decade. Rep. Lloyd Doggett (D-Texas), ranking member of the Ways and Means Health Subcommittee, also voted against the bill, but Congressional Telehealth Caucus founder Rep. Mike Thompson (D-Calif.) and four other Democrats voted for it. “Democratic opposition to access to telehealth for HDHPs is a little puzzling,” said Neil Trautwein, executive director of the Partnership for Employer-Sponsored Coverage. “This is not replacement coverage but rather helps in those odd times when your doctor isn’t available.” Melissa Bartlett, senior vice president of health policy for the ERISA Industry Committee, which represents large employers’ benefits and supports extending the provisions, told Pulse that the House’s move to pass legislation allowing HSAs to cover chronic care predeductible last month gives her optimism. She said Congress is in a “holding pattern” amid uncertainty about how much room there will be in a potential end-of-year package. “We’re fighting to make sure it gets included. Americans are going to lose out if it’s allowed to lapse,” Kyle Zebley, vice president of public policy at the American Telemedicine Association, told Pulse, adding that it might be a shorter-term extension than the Medicare rules. WELCOME TO FRIDAY PULSE. Are you hearing about potential HHS picks in a new administration? We want to hear from you — and can keep you off the record. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com. and follow along @_BenLeonard_ and @ChelseaCirruzzo.   A message from PhRMA: Drug price “negotiations?” Higher costs and less access to medicines are not what seniors were promised when the Inflation Reduction Act (IRA) was signed into law. Learn more about the IRA’s unintended consequences.   AROUND THE AGENCIES The FCC mandated that wireless carriers route 988 crisis hotline calls based on callers' locations, not area codes. | Jon Elswick/AP 988 UPDATE —  The FCC voted Thursday to mandate that wireless carriers route calls to the 988 mental health crisis hotline based on the caller’s location, not their area code, which might not reflect their physical location. The agency has said that connecting people in crisis to local professionals is important because they “may be more familiar with cultural issues or community stressors in the caller’s area.” Some carriers like Verizon and T-Mobile have been routing calls by location, and AT&T will do so in the coming months. The move comes amid a broadening mental health crisis across the nation that the pandemic exacerbated. The hotline has received more than 10.8 million contacts since it launched just over two years ago, according to KFF. FIREWORKS OVER DIETARY GUIDANCE TO COME?   A federal advisory panel will meet Monday and Tuesday to discuss potential changes to dietary guidance that could take a firmer stance against alcohol consumption. Some members of Congress and the beverage industry have raised concerns about an HHS study on the relationship between alcohol and health, fearing the study will influence the dietary recommendations, which are updated every five years. Current guidance calls for limiting men to two daily alcoholic drinks or fewer and, for women, one daily or fewer. Last year, Congress commissioned the National Academies of Sciences, Engineering and Medicine to study alcohol’s effect on health to inform the new guidance, but HHS convened a panel of its own. HHS has defended its study against accusations that it’s duplicative, saying its research complements the NASEM study. Groups representing the alcohol industry have argued that the HHS-led study is biased. HEALTH INSURANCE UNWINDING RIPPLE EFFECTS — Major insurer Elevance Health said Thursday that “unprecedented” impacts from Medicaid redetermination are affecting its bottom line. The company cited a discrepancy between state payment rates and the higher acuity patient population after many patients lost Medicaid coverage when pandemic-era rules ended. “We remain confident in the long-term earnings potential of our diverse businesses as we navigate a dynamic operating environment and unprecedented challenges in the Medicaid business. We expect Medicaid rates will align with the needs of our members in time,” CEO Gail Boudreaux said in a statement. The bigger picture: To obtain enhanced federal funding, Congress mandated that states provide continuous Medicaid coverage. When the Covid public health emergency ended last May, states had to review the eligibility of Medicaid enrollees, and millions of people have since lost coverage. Individuals remaining in the program have generally had more complex and expensive conditions, which has left insurers pushing states to boost payments.   A message from PhRMA:   IN THE STATES VAX RULES UPHELD — New York state’s highest court ruled Thursday that New York City school officials had the right to put unvaccinated teachers on unpaid leave during the pandemic. The Court of Appeals decision comes after teachers who were dismissed when they couldn’t show proof of Covid vaccination at the start of the 2021 school year filed several lawsuits. Close to a thousand Department of Education employees were let go due to the mandate, POLITICO’s Bill Mahoney reports. Still, the decision doesn’t offer broad clarity on the sometimes conflicting decisions from lower courts. It focuses on the specifics of civil service law and is the first case of dozens that have made it to the state’s high court. Teachers argued that the vaccine mandate ran afoul of labor protections guaranteeing them arbitration before facing removal for disciplinary violations. The court found that the central concern wasn’t about discipline but instead a condition of employment. Former Mayor Bill de Blasio put the mandate in place in 2021, and Mayor Eric Adams ended it last year. State and federal vaccine mandates enacted amid the Covid pandemic have faced a number of legal challenges. In Congress EMPLOYERS ON DIALYSIS CHANGE: NOT SO FAST — Amid a significant push for Congress to address a Supreme Court decision impacting dialysis in a potential end-of-year package, groups representing employers are pushing back. The decision has created what dialysis firms call a “loophole” in kidney care coverage, which reform advocates say allows employers to shift costs to Medicare. Lawmakers and advocacy groups are vying to reverse that ruling through legislation in the lame-duck session. The Partnership for Employer-Sponsored Coverage, which represents employers, is firing back , saying the legislation would increase costs for employees and employers without improving quality of care and create “overly broad” requirements comparing dialysis to all other benefits. “While we recognize the concerns expressed by dialysis providers regarding shortfalls in their Medicare payments, it is inappropriate to shift any Medicare underpayments further onto employers,” the group wrote in a letter to Congressional leadership.   A message from PhRMA: Seniors are feeling the true cost of drug price “negotiations.” Instead of saving money, some Medicare patients will pay more for medicines. Others may not be able to get their medicines – 89% of insurers and PBMs say they plan to reduce access to medicines in Medicare Part D because of the Inflation Reduction Act. Higher costs and less access. That’s not what seniors were promised. Learn more.   Names in the News Dr. Laura Cheever, associate administrator of the HRSA HIV/AIDS Bureau, is retiring at the end of the calendar year. She joined HRSA in 1989. Dr. Colleen Kelley has been elected chair of the board of directors at the HIV Medicine Association. She’s a professor at Emory University Medical School. Mark Hirschhorn is becoming chief financial officer at Amwell. He was previously CEO of TapestryHealth. WHAT WE'RE READING Fierce Healthcare reports on how Harris and Trump could approach artificial intelligence regulation. The Wall Street Journal reports that states approve legal marijuana despite it containing dangerous mold. A study in JAMA found that methadone is associated with a lower risk of treatment discontinuation versus buprenorphine/naloxone to treat opioid use disorder.   Follow us on Twitter Dan Goldberg @dancgoldberg Chelsea Cirruzzo @chelseacirruzzo Lauren Gardner @Gardner_LM Sophie Gardner @sophie_gardnerj Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker   Follow us

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