Turmoil and Trouble Buffets Washington

Vaccine mandates expand; transparency faces new lawsuit

The U.S. Department of Health and Human Services (HHS) has ordered its healthcare employees to get the COVID vaccine, making it the second federal agency to do so, after the Veterans Administration (VA) a few weeks ago.

President Biden has already required federal workers and contractors to either be vaccinated or wear masks and social distance – the difference here is that the VA and HHS have now made vaccination mandatory for their healthcare workers, and they are not giving unvaccinated employees the option to simply wear masks and social distance.

The Pentagon then announced that all U.S. military personnel will be required to be vaccinated, starting Sept. 15.

At the state level, Washington State followed California last week by requiring most of their state employees and all government healthcare workers to be vaccinated by mid-October.

In response to hospitalization spikes due to COVID, the governor of Texas last week asked hospitals in the state to voluntarily postpone elective procedures. Texas is also recruiting out-of-state healthcare workers to help, while the governor of Arkansas announced that there were only eight intensive care beds available in the entire state.

Back in Washington, D.C., the U.S. Chamber of Commerce has filed suit against HHS about the healthcare price transparency rules. As listeners may remember, there are several different price transparency requirements that both healthcare providers and payers must  implement.  

First, the hospital price transparency rules – which have been in effect since January of this year – require hospitals to post the prices of more common procedures in what are called machine-readable files, including the prices they have negotiated with specific insurers. Remember that the American Hospital Association (AHA) fought these requirements in court, but ultimately lost to the Trump Administration. 

This latest suit by the Chamber of Commerce centers on the transparency rules that apply to healthcare payers. Like the hospitals’ requirements, the Transparency in Coverage rules require payers to post their negotiated rates.

The argument the Chamber is making in the lawsuit is that these publicly posted rates will not be helpful to consumers, because they’ll be on huge, unwieldy spreadsheets – and based on codes that most consumers will not understand. Therefore, the lawsuit argues, these machine-readable files do not meet their statutory intent of making healthcare prices transparent to consumers. Even the regulators admit that these files will be pretty much unreadable by anyone’s naked eye.

Unfortunately, this is the same argument that the AHA used against the hospital transparency rules, and, as we know, the hospitals lost that argument. The current administration’s defense in this newest lawsuit will be the same the previous administration used against the hospitals; that is, releasing reams of unreadable pricing data, they say, will provide other entities, like third-party app developers and data companies, the opportunity to make this information usable and useful for consumers. Think of how app developers now use databases full of airline data to make travel information usable by consumers.

We’ll see how the lawsuit fares; in the meantime, payers have until Jan. 1 to get these machine-readable files up on their websites, and the Biden Administration has promised enforcement against both hospitals and payers that refuse to post the data.

Programming Note: Listen to Matthew Albright and his Legislative Update sponsored by Zelis, Monday on Monitor Mondays, 10 Eastern.

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Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

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