Our last post listed health policy developments that happened at the end of 2019. This time, we are looking into our crystal balls and making some friendly health policy predictions for 2020.
States are really the primary regulators of the business of insurance, so it’s a no-brainer to make a health policy prediction that state governments will take action on healthcare issues in the year ahead. In 2020, though, we expect even more state-level activity than is typical. Given the uncertainty the Texas v. United States case has created about the status of the Affordable Care Act, some states will take action to further cement state-level market protections and cost controls, particularly for individual market consumers. These reforms could include: passing state-level individual mandates; creating state-level public option plans; or promoting non-ACA coverage options like association health plan coverage and short-term limited duration insurance coverage.
More states will explore Section 1332 ACA waivers to stabilize markets and create new coverage options. To date, most states have used their 1332 waivers to create state-level individual market reinsurance programs. However, in late 2019, Georgia submitted a two-part waiver request to not only create a reinsurance pool but also replace the exchange and premium tax credit subsidies with an innovative private market health access program. It will be interesting to see if the Trump Administration approves this waiver request, and if so, how Georgia will implement it, and if other states might follow suit.
Healthcare cost containment will be a hot topic amongst state-level policymakers. Expect efforts to help consumers deal with surprise out-of-network medical bills; measures to improve the transparency of health care quality and price information; and action to reduce the cost of prescription drugs. At least 20 states plan to take action on surprise billing legislation during the current legislative cycle. Increasing the transparency of healthcare price and quality information will also be a priority for some states, including legislative efforts to boost the transparency of prescription drug prices. We predict other states may create prescription drug affordability review and affordability boards like Maryland, Maine, and Nevada did last year. Federal policymakers will spend some time talking about all of these issues too, but our money is on the state legislators to get the most done on healthcare cost containment in the year ahead.
A policy area where we expect to see both federal and state-level activity concerns the privacy and security of personal health and financial data. The National Association of Insurance Commissioners just started the process of reviewing its model state-level privacy and data security laws, and it also took action on cybersecurity in 2019, which we predict will spread to different states in 2020. Meanwhile, the federal Department of Health and Human Services issued a request for information about potential updates to the Health Insurance Portability and Accountability Act’s privacy rules. So, they could act on tweaks to the federal health data privacy requirements in the year ahead.
We predict most federal health policy action in 2020 will stem from the Trump Administration rather than Congress, which will be bogged down with running for reelection and other political matters. In addition to a possible privacy rule update, look for new action on: wellness programs; qualified medical expenses; and account-based health care options, including flexible spending arrangements, health reimbursement arrangements, and health savings accounts. The Administration will also finalize new health plan transparency rules and a prescription drug reimportation regulation in the first half of 2020 and propose updates to the Family Medical Leave Act rules.
The federal judiciary branch might be the governmental institution that has the most significant impact on health policy in 2020. The Supreme Court of the United States may rule on the status of the ACA by this June. We will know whether they plan to take up the case within the next week or two. While we agree with a wide range of other stakeholders that providing marketplace certainty regarding the ACA would be a fantastic use of the Supreme Court’s time this Spring, we predict that the justices will elect to wait till lower court action in Texas v. United States plays out before hearing the case. This could take more than a year.
Besides the challenge to the whole ACA, there are also federal court cases pending on the law’s contraceptive mandate, federal risk-sharing, and cost-sharing reduction payments. We predict significant decisions regarding the fate of new association health plan rules and short-term limited-duration insurance coverage later this year. Challenges to the Trump Administration’s health care price transparency regulations will come before federal judges in 2020 too.
Finally, our top health policy prediction for 2020 is that the private market will continue to develop new solutions to help individuals and business consumers of healthcare bend the cost curve and access high-quality medical care services. One way it will do this is by continuing to offer new funding strategies for employer-sponsored health plans. We also predict the trend of new tools for employers to help manage their health care costs and improve the health and wellness of their employees to continue in 2020 and beyond!
It’s an exciting time to be involved with providing Americans with healthcare solutions, so buckle up and enjoy the ride friends!