As the Republican-led Congress wrestles with the daunting challenge of developing comprehensive health care legislation to replace the Affordable Care Act, specialty organizations-including those representing urology-are working to influence the ultimate outcome.
Bob GattyAs the Republican-led Congress wrestles with the daunting challenge of developing comprehensive health care legislation to replace the Affordable Care Act (ACA), specialty organizations-including those representing urology-are working to influence the ultimate outcome.
In a letter to Senate Finance Committee Chairman Orrin Hatch (R-UT) in late May, members of the Alliance of Specialty Medicine, including the AUA, provided a list of recommendations for inclusion in the Senate’s version of the legislation, on which Senate leaders have been hoping to take to a vote before the August recess.
The House of Representatives narrowly passed a reform bill, HR 1628, in May, which has raised alarms about potential loss of coverage under Medicaid and for preexisting conditions, among other issues. Differences between the two versions of the legislation would then be negotiated in a House-Senate conference to devise a final bill to be considered in each chamber.
The Alliance’s letter summarized what many specialty groups, including the AUA, have been urging senators individually to consider during meetings on Capitol Hill and elsewhere.
Some provisions of the reform effort are being handled through the budget reconciliation process in Congress, while others that do not have a direct impact on the federal deficit will be included in separate legislation.
Next: Networks must include sufficient specialists
Under budget reconciliation, the Alliance stressed the importance of making certain that provider networks include sufficient numbers of specialists and subspecialists per enrollee. In addition, network directors should be updated in real time and patients provided with clear, concise, and accurate information. Finally, the Alliance said, decisions to remove a physician from the network without cause should not be made in the middle of a contract year.
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“We urge the committee to ensure appropriate oversight to hold insurers accountable to ensure patients have timely access to the right care, in the right setting, by the most appropriate health care provider,” the Alliance’s letter said.
In addition, the Alliance said these provisions should be maintained to ensure access to affordable health insurance and access to specialty medicine:
The Alliance said its recommendations stemmed from the results of a survey of 1,000 provider members to determine the extent to which those issues placed a burden on timely access to specialty care.
“The results indicate that these barriers to care have gotten far greater and more difficult to navigate in recent years,” the Alliance explained.
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As the legislation to be considered through the “regular order” process is developed, the Alliance urged:
Whether the Senate will be able to finalize comprehensive health reform legislation and achieve a vote prior to the August recess was in question at press time. Meeting that time frame would allow lawmakers to return in September and tackle an ambitious legislative agenda, including tax overhaul, funding the government through fiscal year 2018, increasing the debt ceiling to prevent default, and more.
Regardless, however, whatever legislation is finally approved by the Senate is just one additional step toward final enactment, as a compromise bill must be negotiated with the House of Representatives and then both chambers must act before sending a final bill to President Trump.
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