Senator, Health Care Executives Discuss What’s Next in Payment, Access Issues


The head of AHIP sat down with a senator and 3 health care executives for a conversation about payment and access issues at the organization's 2021 Institute and Expo Online.

Earlier this month, a group of bipartisan senators introduced the Telemental Health Care Access Act of 2021, which seeks to allow Medicare beneficiaries to have direct access to mental health care through telehealth. One of those senators spoke at this week’s AHIP meeting about that and other issues, along with 3 health care executives.

At the AHIP 2021 Institute and Expo Online, AHIP CEO Matt Eyles spoke with Senator Bill Cassidy, MD, R-Louisiana, who introduced the telehealth bill along with fellow Republican John Thune, South Dakota, and Democrats Tina Smith, Minnesota, and Ben Cardin, Maryland.

Last year’s appropriations package permanently expanded access for Medicare patients to be treated in their home and other sites for mental health services by removing geographic restrictions, but instead required that an individual would have to be seen in person within 6 months when using telehealth for mental health care.

Eyles asked about future prospects for lowering the cost of care through telehealth or by shifting to care at home or in the community, and Cassidy mentioned another bipartisan bill, the Connected Maternal Online Monitoring Services (MOM) Act, which would require CMS to provide coverage recommendations for remote monitoring in pregnant women who may be at risk of complications.

“Our nation has too high a rate of maternal mortality,” said Cassidy.

Referencing last week’s Supreme Court decision about the Affordable Care Act, Eyles also asked Cassidy about the prospect of other Congressional actions related to health care coverage.

“Well clearly, the American relief plan increased the subsidy for people on the exchanges, reducing out-of-pocket expenditure to zero or near zero for a whole fraction of folks,” said Cassidy, referring to the $1.9 trillion American Rescue Plan (ARP), which he and others in his party did not support.

However, the subsidies that lower premiums for plans bought on the exchange expire in 2 years. President Joe Biden’s budget proposal seeks to make premium tax credit expansion permanent; in addition, the administration has included permanent relief in another mammoth piece of legislation, the American Families Plan.

The Biden administration is also being pressured by House Democrats to lower the age of Medicare eligibility to age 60; covering 23 million additional Americans would add $200 billion over 10 years.

Cassidy claimed Democrats will have to do that under the reconciliation process.

“Republicans are concerned that, right now, Medicare is going bankrupt in 6 or 7 years, so you're about to add new people to it,” he said. Cassidy was apparently referring to the Medicare Hospital Insurance trust fund, out of which hospital benefits are paid under Part A; a recent Kaiser Family Foundation analysis noted that although the Congressional Budget Office has estimated that the fund could be deleted by 2026, lawmakers have not allowed that to happen during the program’s history.

In a separate discussion, Eyles spoke with Jaewon Ryu, MD, JD, president and CEO, Geisinger; Ramona Sequeira, president, Takeda US Business Unit and Global Portfolio Commercialization; and Vivian S. Lee, MD, PhD, MBA, president, Verily Health Platforms, the digital health company owned by Alphabet, the parent company of Google.

Even as digital health expands, payment should still be paid based on “pay for performance,” Lee said.

“I think there's a huge opportunity for digital health and for the payers to set this expectation that digital health not be pay-for-click,” she said.

Ryu said lowering costs also means recognizing that “one size does not fit all when it comes to how do you deliver care,” citing, as one example, the Geisinger at Home Medicare Advantage program.

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