After productive year in 2022, health care policymakers expected to focus on implementation
“This was a busy past Congress, and a lot ended up happening,” says Joel White, president and CEO of Horizon Government Affairs.
Despite the usual partisan bickering and election year posturing, lawmakers had a productive year in enacting health care policy in 2022.
“This was a busy past Congress, and a lot ended up happening,” says Joel White, president and CEO of Horizon Government Affairs. “I would say the most significant thing was the Inflation Reduction Act. That was the biggest change in drug pricing and the approach to drug pricing in 40 years. With the negotiated drug price controls in that law, it will fundamentally redesign how drug pricing works and how markets operate around prescription drugs.”
White shared his insights during The Year Ahead in Health Policy, a Jan. 18 webinar sponsored by The Commonwealth Fund. Panelists reviewed highlights of the past year, such as the expansion of public health care programs.
“For the first time in a very long time, we saw significant expansions to both Medicare and Medicaid,” says Melanie Nathanson, a principal at Nathanson+Hauck. “On the Medicare side, it allows mental health professionals who otherwise were not able to participate in the program participate for the first time.
“On the Medicaid side, we have a mandatory permanent expansion of 12-month continuous eligibility for children. It’s really hard to expand out these programs, so that may seem small in comparison to a landmark change in drug policy, but really it’s quite large.”
Sabrina Corlette, research professor at the Center on Health Insurance Reforms at Georgetown University, expects the expansion of premium tax credits in the Affordable Care Act to have a far-reaching impact.
“As a result, we have seen unprecedented high enrollment in the Obamacare marketplaces,” she says. “This may help people who lose Medicaid coverage this year as a result of the end of the continuous coverage requirement. If they are eligible for the marketplace, it will make that transition much smoother.”
Josh LaRosa, policy director at the Wynne Health Group, was impressed by the ability of Congress to come together on several policy issues.
“There was a lot of `will they/won’t they’ leading up to the omnibus appropriations bill,” he says. “A lot of folks were pleasantly surprised at the level of bipartisanship and the measures that ultimately were included. Not to be overly optimistic, but hopefully it bodes well for the next Congress in terms of their ability to turn out some bipartisan work. “
Now comes the hard part of actually implementing this new legislation.
“I take pity on the regulators, because they are going to have a busy 2023, 2024, 2025 and into the future,” White says. “The drug pricing piece is the thing that Congress is paying the closest attention to. The primary reason is because the law says that the Department of Health and Human Services can implement the law outside the normal rulemaking process.”
The Biden administration has several issues on its 2023 agenda.
“I think we will see a lot of administration activity on issues such as public health and the continued COVID-19 response, and continued work on mental health access, reproductive health and prescription drugs,” LaRosa says. “We also are looking to see new models out of the CMS innovation center that would be focused on lowering drug prices.”
Much of the work ahead will be done behind the scenes.
Read more: Divided Congress likely to result in incremental changes on health care policy
“In my mind, the 118th Congress is going to be less legislatively robust,” Nathanson says. “The 117th Congress did a lot of health care in 2022, but I think health care is always going to be a discussion point. There always are going to be bipartisan successes. A lot remains to be seen, but I feel really bullish about members of Congress in both chambers, on both sides of the aisle, continuing to have conversations and fine-tuning pieces of healthcare legislation that did not get done
“I remind everyone that it takes a long time to get meaningful bills done. Just because something doesn’t get done in one Congress, it doesn’t mean one should give up on it.”