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Health and Human Services Secretary Xavier Becerra said Thursday that the department may readjust Medicare Part B premiums next month while it looks to work with Congress on other healthcare reforms in his second year on the job.
As Becerra approaches his one-year anniversary in the position, he’s also fighting an uphill battle for more funding from Congress to keep COVID-19 relief and health coverage initiatives alive. HHS is interested in talking to Congress about Medicare Advantage overpayment issues and physician payment reform, Becerra told reporters Thursday.
“We can’t let this go over the cliff. Not when we’re on the verge of turning the page,” he said.
Part B premiums
The Centers for Medicare and Medicaid Services’ plans for reassessing Medicare Part B premiums for 2022 will come soon, and Becerra said HHS will ensure seniors don’t pay more than necessary.
Becerra directed CMS to reassess Medicare Part B premiums in January after drugmaker Biogen slashed the price of its controversial Alzheimer’s drug, Aduhelm. CMS announced in November that covering Aduhelm would increase premiums by 15%. CMS has since proposed only covering the drug in clinical trials. A final coverage decision will come in April.
“Once we have that determination, we’ll be able to fully assess what impact Aduhelm may have had on premiums for seniors in Medicare,” he said.
Medicare Advantage
Becerra also indicated the department could look to Congress for help reforming the Medicare Advantage program in the future. However, he didn’t commit to how HHS would address some experts’ concerns that Medicare Advantage plans are overpaid, relative to traditional Medicare. Insurers dispute claims of overpayment.
“We’re taking a close look at Medicare Advantage and working with our partners at (the Office of Management and Budget) and will try to make sure that we’re putting before Congress any reforms that will give Americans a better value for their Medicare buck,” he said.
The Medicare Payment Advisory Commission—along with other health policy experts—has advised that HHS can take steps itself to level plan payment, like increasing the coding intensity adjustment, but the agency has not done so.
Physician payment
HHS is interested in discussing physician payment reform with lawmakers, Becerra said. Congress last year partially offset cuts CMS made to provider Medicare reimbursement that mainly impacted specialists. Physicians want a more permanent fix to their payment system that keeps up with inflation and practice costs.
The agency will examine provider payment where it can, but would support physician fee schedule reforms.
“I remember those cliffs when I was in Congress; we always have to deal with those, and you’d never want professionals… thinking that there may be a different profession for them down the line because they’re just not making ends meet where they are,” he said.
HHS is working to increase the pipeline of providers as well, particularly in underserved areas, Becerra said.
Transparency
The department will continue its push towards transparency in healthcare, separate from its work with Congress, Becerra said. HHS will follow through on enforcing the No Surprises Act, which protects patients from surprise medical bills. The agency will try to give providers time to become compliant but there should be no excuses, he said, adding that providers will pay a price for not following transparency laws.
“We’re going to try to make sure that we do aggressive oversight, so that when, in fact, you haven’t followed the laws where you’re supposed to be a little bit more upfront, we can let it be clear that you pay a price,” he said.
While a recent federal court recently overturned the surprise billing dispute resolution process, the department could appeal the ruling and related lawsuits are still pending. The process came under fire from providers, who said it gave insurers the upper hand when dealing with surprise bills.
Need for funding
But HHS needs more money from Congress, specifically to fund continued COVID-19 relief and prevention. Though cases have plummeted around the country since the winter’s surge, they’re rising again abroad.
Becerra went to Capitol Hill Thursday morning to urge lawmakers for more COVID-19 funding. Without new cash, the uninsured fund that reimburses providers for treating and vaccinating uninsured people against COVID-19 will close next week. HHS may not even have enough money left to pay every claim that comes in by next week, Becerra told reporters.
“I’m going to try to let them all know that there’s a price tag to all that,” he said.
HHS also needs Congress to pass a budget that builds on gains in record-high Affordable Care Act coverage this year, Becerra said. Enrollment in exchange plans grew to more than 14.5 million this year, due, in part, to assistance from navigators who helped people figure out which plans to enroll in. The Trump administration slashed funding for navigators, but the Biden administration made $80 million available for navigators for the 2022 plan year. HHS needs money to continue that, Becerra said.
Lawmakers also authorized premium tax credits for people earning up to 400% of the federal poverty line to use on the health insurance exchanges. The credits will expire at the end of the year, unless Congress moves to extend them.
“No doubt, we need help to make all these things click. The president is committed to it. We’re committed to executing it. We need Congress’ help,” he said.
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