Employer Groups Outline Health Policy Priorities to Congress

As Congress considers another round of legislation in response to the coronavirus pandemic, employer groups are laying out their health policy priorities to lawmakers. In a recent letter to House and Senate leaders, large employer groups joined with more than 30 other organizations in offering recommendations to support employers “central role” in ensuring access to "high quality, affordable healthcare" during the pandemic.

The American Benefits Council, the ERISA Industry Committee, the National Alliance of Healthcare Purchaser Coalitions, and the Pacific Business Group on Health are the four main employer groups behind the letter, which outlines the following specific recommendations: 

  • Ensure sufficient COBRA subsidies to protect patients, covering 90-100% of the cost for those who have lost their jobs or have been furloughed.
  • Increase telehealth coverage and care for the duration of the crisis.
  • Pair longer term coverage policies with policies that aggressively seek to reduce health care prices and increase value for all payers, embodied by the bipartisan Lower Health Care Costs Act (S 1895) as approved by the Senate Health, Education, Labor and Pensions Committee.
  • Provide immediate financial assistance to ensure primary care practices can survive the sudden and significant loss of revenue and can continue to serve their patients.
  • Expand opportunities for physician practices to participate in value-based, prospective, population-based payment models that increase investment in primary care.
  • Allow, but do not require, high-deductible health plans to waive all or part of cost sharing for primary care visits for the duration of the public health emergency.
  • Require health care provider organizations to certify they will not engage in mergers or acquisitions of other provider organizations for 12 months as a condition of receiving CARES Act funding.
  • Cap costs for mandated out-of-network coverage by requiring that any COVID-19-related services that must be provided without patient cost-sharing be paid according to the Medicare fee schedule.
  • Enforce a ban on price-gouging for any health care items or services.
  • Enact a solution to surprise medical billing through the use of a local, market-based payment rate for surprise medical bills.
  • Enact policies to protect self-insured employers and health plans from unexpected costs in the 2020 and 2021 plan years.

In a statement to news media supporting the letter, American Benefits Council President James Klein said, “Now is not the time to debate a radically new health system. The fastest way to ensure continuation of vital health coverage and peace of mind is to strengthen employer-provided health coverage that serves 178 million Americans. That means enabling workers to maintain coverage even if they have lost their job and protecting them against surprise billing.”

The path forward for additional coronavirus relief legislation is uncertain. The Democrat-controlled House approved the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (HR 6800) on May 15. At this time, neither the Republican-led Senate nor the White House have signaled a timeline for further negotiations.

The HEROES Act addresses some of the employer recommendations in the letter, including a 100% subsidy of health plan premiums for terminated or furloughed workers enrolled in COBRA, from March 2020 through January 2021. The legislation also prohibits medical providers receiving government financial aid from balance billing patients for COVID-19-related testing and treatment, and creates a government program to reimburse employer health plans — including self-insured plans — for certain COVID-19-related costs for plan years 2020 and 2021.

Geoff Manville
by Geoff Manville

Partner, Mercer’s Law & Policy Group

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