HEALTH CARE BRIEFING: Surprise Billing Fix Eyed in Next Stimulus

By Brandon Lee and Alex Ruoff

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Leaders of pivotal congressional health panels want to include a fix for surprise medical billing in the next coronavirus-response package, aides and lawmakers said.

House Energy and Commerce ranking member Greg Walden (R-Ore.) is pushing to get surprise billing legislation into a future package to address the impacts of the pandemic. Walden said that he has been working with Chairman Frank Pallone (D-N.J.) on the problem.

“We need to get it done and we need to get it done now,” Walden said Monday on C-SPAN. Pallone told reporters separately on Monday that he’s working with Walden on what could be in a fourth coronavirus legislative effort, but stopped short of saying surprise medical bill legislation should be included.

Surprise billing legislation aims to end instances in which people with insurance end up paying high fees for health-care services, often because of unexpectedly getting treatment from doctors outside the insurance network. Battles between insurers and health-care providers over how to shape such a solution have kept legislation from passing.

Democrats also want to make health-care services free to people who contract the coronavirus, Pallone said. Education and Labor Chairman Bobby Scott (D-Va.) said that if treatment becomes free, those with the virus wouldn’t have to fear surprise medical bills.

Walden tried to include in previous coronavirus legislation an agreement he and Pallone had struck with Senate Health, Education, Labor and Pensions Chairman Lamar Alexander (R-Tenn.) late in 2019 meant to end “balance billing” and cap some out-of-network charges that insured patients faced when seeking emergency room care. Senate leaders decided against including the provision in any of the three bills that cleared Congress, aides said.

Separately, Sen. Bill Cassidy (R-La.) is also pressing for surprise billing provisions related to coronavirus testing and treatment, according to a Cassidy spokesman. Read more from Alex Ruoff.

Trump Warns of Painful Weeks With Death Toll of 200,000

President Donald Trump warned Americans yesterday that the country faces “a very tough two weeks” ahead as deaths from Covid-19 are expected to peak. The top public health official coordinating the coronavirus task force said as many as 200,000 Americans are projected to die from the virus in the coming months.

“This is going to be a painful two weeks,” Trump said at a White House briefing. “Our strength will be tested. Our endurance will be tried.” His somber presence stood in contrast to an optimistic, upbeat tone he’s projected in prior briefings.

The data that virus task force coordinator Deborah Birx revealed was the same information that propelled Trump to retreat from ambitions to urge Americans back to work by Easter. He made the comments, even with another 30 days of the most stringent public health restrictions in place.

The leading scientists on the White House Coronavirus Task Force have said that several public studies bolster their belief that the coronavirus could bring with it an even greater death toll in the coming weeks. The projection by the University of Washington’s Institute for Health Metrics and Evaluation predicts that the toll will dramatically spike in April from roughly 4,500 to almost 60,000 people, even with the isolation measures in place around the country.

During the briefing, a slide was displayed showing one projection where even with efforts by communities to mitigate the virus, deaths could reach as high as 240,000.

The soaring rate of infections is expected to strain hospitals that are already struggling to care for infected patients and obtain desperately needed medical supplies. The University of Washington study projects that at the outbreak’s peak, roughly 220,000 hospital beds and 26,000 ventilators will be needed.

By April 15, when the death count is expected to peak, over 2,200 Americans will die of the disease per day, according to the model. Both Trump and Birx pointed to the University of Washington report on a call with governors earlier this week. The study indicates that the pace of deaths will level in May and June, eventually reaching almost 84,000 by the first week of August. Read more from Justin Sink and Mario Parker.

White House Will Not Reopen Obamacare Enrollment for Virus: Trump will not reopen the Obamacare exchanges to allow uninsured Americans to purchase health care coverage during the coronavirus pandemic, a White House official said Tuesday night. The decision comes after the president said last week he was considering a special enrollment period to allow individuals to purchase insurance during the crisis — a move that had been endorsed by America’s Health Insurance Plans, the trade organization representing health insurers.

Ultimately, however, the administration opted against a national mandate that would have mirrored steps that states like New York, California, Connecticut, and Maryland are taking. In New York, people without insurance “can apply within 60 days of losing coverage,” according to the state website. Read more from Justin Sink.

Combating an Equipment Shortage

Seeking Consensus on Mask Wearing: Federal officials are actively discussing whether all people should wear masks in public amid the pandemic, Health and Human Services Assistant Secretary Brett Giroir told Fox News. Giroir, who said he isn’t ready to give his opinion on the topic yet, said that the issue concerns whether asymptomatic carriers of the virus can protect others by wearing a mask. “We’ll have aconsensus opinion very, very soon about that,” he said.

Separately, Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases, told CNN that the Trump administrations task force is discussing the wider use of masks. He said there’s still a shortage of masks and commercial ones need to be prioritized for health-care workers. Jordan Fabian and Vivek Shankar have more.

One Ventilator, Two Patients: Hospitals, as “an absolute last resort,” may put two Covid-19 patients on a single ventilator, the HHS said in an open letter. The department gave hospitals the green light as they prepare for the possibility of not having enough ventilators to care for all the patients who are struggling to breathe while ill with Covid-19. Hospitals should first use other ventilator types—like those used for anesthesia, transporting patients, and sleep apnea—prior to co-venting patients, Surgeon General Jerome Adams and HHS’s Giroir said in the letter released yesterday.

Putting a patient on a ventilator is already very risky. It comes with a 40% to 60% mortality rate, according to physician and patient safety organizations, including the Society of Critical Care Medicine and American Society of Anesthesiologists. There are “significant technical challenges” to using a single ventilator for more than one patient, according to the groups, including an unequal distribution of gas. Read more from Shira Stein.

Ventilator Patient Drugs Run Low: Demand for medicine given to patients on ventilators is outstripping supply, said pharmaceutical-purchasing group Vizient, which works with over half of U.S. hospitals and health systems. Hospital orders for sedatives, analgesics, and neuromuscular inhibitors increased 58% overall in March compared with January, Vizient said. The medications are used to prevent movement, manage pain and soothe patients who can’t breathe without the aid of a machine. Read more from Riley Griffin.

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Research, Testing & Treatment

Medical Groups Eye More Relief: Health industry leaders expect Congress will need to send billions more to hospitals and doctors this year, even before any of the $100 billion in emergency funds signed into law last Friday are doled out. Hospital and doctors’ groups say that they’re pushing on two fronts: getting the emergency funds to providers right now and persuading lawmakers to provide more money.

Health organizations are asking HHS to start dispensing the funds as soon as possible to help keep afloat hospitals, health centers and doctors’ offices that have been responding to the outbreak. Some want the agency to use the emergency fund to forgo collecting Medicare advanced payments, essentially letting the federal government pay doctors immediately with the public health insurance system. Read more from Alex Ruoff.

  • Yesterday, the American Hospital Association urged HHS Secretary Alex Azar and CMS Administrator Seema Verma to “directly and expediently distribute to rural and urban hospitals and health systems” the money from the public health emergency fund in the stimulus legislation amounting to $25,000 per hospital bed, or $30,000 per bed in coronavirus “hot spots.”
  • Meanwhile, hospital losses are mounting as they suspend elective surgeries from revenue streams. “There’s intense stress on the balance sheet—across the board,” Wells Fargo Securities analyst George Huang said. “Hospitals are burning through cash very quickly.” While the newest stimulus measure will help prop up hospitals in the immediate future, analysts warned that more money will be needed to stem losses and the drain on reserves. Shruti Date Singh and Lauren Coleman-Lochner have more.

Loosened Federal Health Rules: The White House is playing catch-up, relaxing and temporarily scrapping rules that some hospitals have already had to ignore as they cope with a flood of patients, dwindling supplies and a shortage of staff. Agencies have waived rules for nursing homes, boosted insurance coverage for testing under Medicare Part B, and eased some patient privacy regulations. The Centers for Medicare & Medicaid Services went even further this week, making an array of changes to allow hospitals to treat more people in temporary facilities, relieve them of certain paperwork and beef up their workforce, Valerie Bauman and Lydia Wheeler report.

Insulin During Outbreak: The drug pricing advocacy organization Patients for Affordable Drugs sent letters to the heads of the three major makers of insulin asking them to lower their prices during the coronavirus pandemic. The group, along with dozens of insulin users, penned the letter to executives with Eli Lilly, Sanofi and Novo Nordisk saying financial hardships will worsen during the outbreak in the U.S. and their current charity programs aren’t enough to help diabetic people weather the storm, Alex Ruoff reports.

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Wider Effects of the Outbreak

Abortion Limits During Outbreak: The coronavirus is adding new ammunition to America’s abortion wars, with several states putting in place limits against the procedure and saying abortions are non-essential services during the pandemic. Those restrictions have prompted legal challenges and a flurry of judicial rulings—yesterday, judges in Texas, Ohio, and Alabama blocked the state actions. One state has already seen that decision put on hold: a judge panel at a New Orleans appeals court temporarily halted the Texas judge’s order on a 2-1 vote. This will allow Texas to continue to ban most abortions until judges can more fully weigh the issue on an accelerated schedule.

It’s not just red states that are seizing on the virus to advance their positions. A group of 21 blue states urged the Trump administration to ease restrictions on a medication-induced abortion prescription drug, noting that many women are currently unable to seek in-person care. And one Democratic-led group is vying to get the federal government to lift a ban on fetal tissue research, arguing that a search for a cure for coronavirus needs to be a “top priority.” Patricia Hurtado, Cynthia Koons, and Edvard Pettersson have more.

Filling Prescriptions During Crises: Reps. Annie Kuster (D-N.H.) and Lucy McBath (D-Ga.) unveiled a measure yesterday that would seek to make sure “consumers receive notice if they are able to fill their prescriptions in advance during public health emergencies,” according to a statement. Their bill, formally introduced on Friday, would require health insurance providers to give families notices of their options “to collect more of their necessary prescriptions at one time.” This could reduce the time that Americans would need to spend in public areas like a pharmacy, the statement says.

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What Else to Know

Groups Say Judge Pick Would Undermine ACA: Liberal leaning advocates and health groups are urging lawmakers to oppose confirming the latest White House pick for one of the most conservative federal appeals courts on the grounds that he would to undermine Obamacare. In op-eds from 2012, 2013 and 2014 when he was a lawyer in private practice, Cory Wilson encouraged the Supreme Court to strike down the health law and called it “illegitimate” and “perverse.”

Those remarks indicate that Wilson would rule against the Affordable Care Act if a related case came before him on the U.S. Court of Appeals for the Fifth Circuit, the groups said in a letter sent to senators on the Judiciary Committee. The Fifth Circuit has been a key stop for challenges to the embattled health law. Madison Alder has more.

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To contact the reporters on this story: Brandon Lee in Washington at blee@bgov.com; Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: Giuseppe Macri at gmacri@bgov.com; Zachary Sherwood at zsherwood@bgov.com; Michaela Ross at mross@bgov.com

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