July 31, 2020: National Advocacy Update

The AMA alongside 114 state medical societies and national specialty organizations sent a letter to Congressional leaders opposing efforts to include surprise medical billing provisions in the new COVID-19 relief legislation. The letter makes the point that legislation to address the current public health emergency is not the appropriate vehicle or time to address this issue when agreement on significant outstanding issues remains elusive.

While it is critical to protect patients from surprise medical bills, and a thoughtful measured federal solution is possible to achieve, now is not the time to be wading into this divisive issue. The medical community remains committed to working with Congress to seek a broader solution that protects patients from unanticipated medical bills when their insurer fails to provide them with an adequate network of physicians. It is imperative that any solution should facilitate a process to quickly, efficiently and fairly resolve physician and health plan billing disputes. The complexity and multifaceted nature of the issues pertaining to surprise medical bills warrants due consideration from Congress but should be addressed separately from any COVID-19 relief legislation.

The President signed four new executive orders (EO) on drug pricing on July 24. On a call with the White House last week, the Administration noted that the fourth EO would only go into effect if the drug manufacturers do not come to an agreement with the Administration on lowering costs. Access to Affordable Life-Saving Medications This EO would direct the Secretary to establish a program that conditions grants to Federally Qualified Health Centers (FQHC) on their ability to establish programs allowing certain individuals to purchase insulin and epinephrine at the discounted price paid to acquire the drug under the 340B program. Increasing Drug Importation and Lowering Prices for American Patients This EO directs the Secretary to take action to allow drug importation through three programs:

• Grant waivers allowing for personal importation of prescription drugs, without limit on drug type or country of importation, so long as they meet program requirements ensuring safety.
• Authorize the re-importation of insulin products at lower costs.
• Finalize earlier proposals to create state-based importation programs allowing importation of certain drugs from Canada.

The AMA submitted comments on the Administration's previous proposal to create state importation programs, raising concerns about the ability of these programs to ensure safety and to successfully secure lower-priced drugs from Canada.  Lowering Drug Prices for Patients by Eliminating Kickbacks to Middlemen This EO directs the Secretary to complete the rulemaking process on earlier proposals pertaining to drug rebates. That proposal would end safe harbor protections for price reductions not applied at the point of sale and would create a new safe harbor for those passed on to patients at the point of sale. The EO notes that before this rule is finalized there must be confirmation that it does not increase federal spending. The AMA provided comments on the proposed rule, generally supporting measures to pass drug price reductions directly to patients, but raising concerns about the potential unintended consequences, such as increased premiums and the potential to see no reductions in drug list prices.

Bipartisan legislation introduced in the House of Representatives by Representatives Cindy Axne (D-IA) and Neal Dunn, MD, (R-FL) on July 29 ensures that financial assistance provided by the federal government to hospitals, individual physicians, physician practices and other providers is not subject to taxation and still tax deductible. The CARES Act authorized $175 billon to the Public Health and Social Services Emergency Fund (PHSSEF), commonly referred to as the Provider Relief Fund, to help physicians and other entities cover expenses and lost revenue associated with the coronavirus pandemic. Shortly before the July 15 revised tax deadline, the Internal Revenue Service (IRS) declared that the Provider Relief Funds are subject to federal taxes and entities receiving the resources are not permitted to take tax deductions. The Eliminating the Provider Relief Fund Tax Penalties Act of 2020 ensures that any recipients of Provider Relief Funds, such as individual physicians or physician practices, are not subject to taxes–and expenses attributable to the grants retain tax deductibility. Enactment of this legislation will help physicians receiving Provider Relief Funds avoid tax penalties of at least 21 cents on the dollar. The bill introduced by Reps. Axne and Dunn comes on the heels of the AMA joining 18 other physician, provider, dental, hospital and business organizations on a letter to House and Senate Leadership in support of shielding Provider Relief Funds from taxation.

On July 27, Patrice A. Harris, MD, MA, immediate past president of the AMA, participated in the second annual Black Maternal Health Caucus (BMHC) Stakeholder Summit hosted by Caucus co-chairs Reps. Lauren Underwood (D-IL) and Alma Adams (D-NC). The Caucus has over 100 House members and its mission is to eliminate health disparities, and in particular, address the Black maternal health crisis in the U.S. that has resulted in Black women being three to four times more likely to die from pregnancy-related causes than their white female counterparts. Dr. Harris' remarks recognized that the U.S. is one of only three countries where maternal mortality is rising, that it disproportionately impacts women of color, and it occurs at the intersection of racial and gender discrimination. She went on to state that, "there are a multitude of considerations necessary to address the epidemic including lack of insurance or adequate coverage prior to, during and after pregnancy, closure of maternity wards in rural and urban communities and lack of interprofessional teams trained in best practices." To address this crisis, Dr. Harris cited AMA support for:

• Expanding the efforts of Maternal Mortality Review Committees
• Implementing equitable standardized data collection methods
• Expanding access to medical and mental health care and social services for post-partum women
• Expanding Medicaid and CHIP coverage to 12 months post-partum
• Continuing to develop a diverse health care workforce
• Addressing shortcomings in our institutions
• Adopting standards to ensure respectful, safe and quality care before, during and after delivery

Dr. Harris closed her written remarks saying that the AMA is committed to working with Congress and the Administration to address this crisis.

• July 31, 2020: Advocacy spotlight on Senate Republicans unveil details of fourth COVID-19 relief package
• July 31, 2020: State Advocacy Update