Politics in 2016: What to Expect When You’re Expecting a New President

By Julie Barnes, Director of Health Policy
December 16, 2015
policy and politics

By Julie Barnes

Health care issues will be prominent in the presidential election campaign in 2016, particularly now that Congress has offered end-of-year tax relief gifts that will mean less money to fund the Affordable Care Act programs. Here are some of the major trends you will be hearing about in 2016:

Insurance Market Evolution. The change underway in the insurance industry is difficult to overstate. Here’s why:

Insurers Will Merge: United, Anthem and Aetna will control 44% of the U.S. insurance market and the Blue plans will evolve to compete.

Hospital Systems Will Offer Insurance: Provider-owned health plans will continue to launch and grow as more hospitals take on financial risk under value-based contracts.

Consumers Rule: Price sensitivity to higher deductibles and co-insurance mean that consumers will need more help with price and quality transparency. Expect new website tools and services to become more consumer-friendly, changing the nature of how insurers and employers handle benefits.

The Provider Reimbursement Model Is Brand New: Gone are the days that insurance companies paid a fee for a medical service. Now insurers must know how to assess who among its provider network offers the highest quality, most cost effective care and reward them on that basis.

The Affordable Care Act Continues In Crisis Mode. Congress delayed the Cadillac Tax, the Health Insurance Tax, the Medical Device Tax, the small business expansion, and woefully underfunded the risk corridors program that allow insurers to remain financially stable while the health insurance exchanges enroll a bigger and more balanced population. These and many more ongoing ACA issues will result in the continuation of a debate (and litigation) about whether the Act is working.

Drug Prices Are Insufferable. All causes of increased health care costs continue to be a national embarrassment, but the lack of transparency around prescription drug price-setting is going to receive increased scrutiny by Congress in 2016. The Trans-Pacific Partnership agreement about drug patent longevity, the 21st Century Cures Act (and the brand-name drug, generic and biosimilar pipelines being considered in it), and the Senate Finance Committee’s investigation of the Sovaldi drug prices that caused many Medicaid Programs to ration coverage will all demand attention if not solutions.      

Here is what is going on in our Regence states:

Oregon 2016 Session

Opens February 1, adjourns March 6.  Candidates for 2016 election must file by Mar. 8.

Key issues expected:

  • Rx: Biosimilars dispensing regulation, specialty tier regulation
  • Providers: dialysis benefit restrictions
  • Assorted wage and tax issues as “compromise alternatives” to ballot measures

Idaho 2016 Legislative Session

Convenes January 11, adjourns near the end of March. Candidates for 2016 must declare by March 11.

Key issues expected:

  • Biosimilars – Notice of Substitution
  • Medication Synchronization
  • Telemedicine – Coverage and Equitable Reimbursement Requirements
  • Oral Chemo Parity
  • Formulary Transparency – Cost Disclosure Requirements

Washington 2016 Legislative Session

Opens January 11 and adjourns March 10. The filing deadline for 2016 candidates is May 20.

Key issues expected:

  • Rx: Price transparency, specialty tier regulation, formulary standardization/transparency
  • Providers: “surprise billing” solution, credentialing timeline, interstate medical licensure compact
  • Medical Management: Comprehensive “benefit manager” regulation, prior authorization standardization, PBM regulation

Utah 2016 Legislative Session

Opens January 25, adjourns March 10.  Candidates for 2016 election must file by March 17.

Key issues expected:

  • Rx: Biosimilars dispensing regulation, specialty tier regulation
  • Telemedicine; in person and telehealth parity reimbursement
  • Expanding residential treatment center licensure requirements
  • Individual market insurance reform
  • Emergency room balance billing reform

Stay tuned

Regence’s Government Affairs team will be monitoring and tracking these issues with more news and analysis to come as developments unfold throughout the year.