Clearly, the President of the United States (POTUS) has a full agenda; he is consumed with pandemic mitigation, environmental concerns, financial stimulus payments and a host of other priorities – but there should be no doubt that healthcare change is coming.

Viewpoints from Craig Hasday

President Biden’s first step was to expand the open enrollment window for individual coverage on the Affordable Care Act (ACA) exchanges until May 15.

This is largely an optics move since anyone with a loss of coverage would experience a qualifying event, triggering an enrollment option at any time.

The transition of leadership in Washington will no doubt bring significant changes to healthcare.

President Biden has signaled that he intends to roll back many of the initiatives the Trump administration designed to water down, if not completely neuter, healthcare that was redefined by the ACA.

But I don’t expect that one very impactful law enacted under the Trump term will be undone.

In December, President Trump signed the Consolidated Appropriations Act (CAA) which includes the No Surprises Act. The provisions of these laws dovetail with President Biden’s agenda.

The laws make significant inroads on cost transparency and the elimination of surprise billings.

The No Surprises Act requires that beginning January 1, 2022 consumers can receive a good faith Advanced Explanation of Benefits before healthcare is delivered. They will also be protected against surprise billing from an out-of-network provider in conjunction with an in-network stay unless there is advance consent, which is allowed only in non-emergency situations. For the consumer, liability is limited to the plan’s in-network cost sharing. Settlement of payment disputes between the provider and the health plan would be done with a federally prescribed arbitration process.

Perhaps the most significant component of this law is the removal of gag clauses which restrict disclosure of provider price and quality measures.

Provider discounts have been closely guarded by health insurance networks and plan actuaries will waste no time comparing the effectiveness of their discounts with the competition.

Healthcare change has been on the horizon for many years. The time for change may well have arrived.

 

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EPIC offers these opinions for general information only. EPIC does not intend this material to be, nor may any person receiving this information construe or rely on this material as, tax or legal advice. The matters addressed in this article and any related discussions or correspondence should be reviewed and discussed with legal counsel prior to acting or relying on these materials.

 

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Craig Hasday Headshot
Craig Hasday

President, National Employee Benefits Practice