By Liam Selfors

Need a quick refresher on current healthcare legislation in the United States? Brush up on your acronyms and jargon with These 12 “Must-Know” Pieces of U.S. Health-Care Legislation.

As health care continues to be a major topic of debate in Washington D.C., government affairs experts in the biohealth field voiced a need for a healthcare system incentivized to reduce costs, increase quality of care, and improve patient outcomes at the Wisconsin Biohealth Summit 2017.

In their morning Breakout Session, moderator Brian O’Connor, Vice President of Alliance Development at Advamed, discussed the industry impact of upcoming health-care reform legislation with panelists, Rachel Roller, Senior Vice President of Community and Government Relations at Aurora Healthcare and Patrick Plues, Senior Director of State Government Relations at the Biology Industry Organization.

Current Political Forces in Health Care

Despite speculation that the issue will go away, there is still activity after the five failed attempts from the GOP to repeal and replace the Affordable Care Act, Obama’s 2010 health insurance reform. “I don’t know if you’ve been paying attention to D.C., but predictions aren’t really something we’re doing very well right now,” O’Connor joked.

With tax reform and executive appointments piling up in the Senate, the most recent failed effort in the Senate is expected to be the last for a while, according to Rachel Rollers. However, the focus to repeal and replace continued only two days after the Summit event with the signing of an executive order aimed at increasing the number of choices available to people who buy their own health insurance, a follow-up to Trump’s first executive order targeting Obama’s Affordable Care Act.

Patrick Plues discussed the recently passed Food and Drug Administration (FDA) Reauthorization Act of 2017 which reauthorizes the Prescription Drug User Fee Act (PDUFA), an act that governs how the FDA approves products, as well as User Fee Amendments to medical devices, generic drugs, and biosimilar products.

While the FDA is often looking to make large changes that complicate the pharmaceutical and medical device industries, the bill cleanly add patient engagement to the drug approval process. With many manufacturers developing products for very small patient populations, it’s important to consider increased patient engagement for best course of treatment.

Moving Forward

So how can players in the biohealth industry tread water in an unpredictable new frontier of health care reform? Advocates for a strengthened health care system should be primarily focused on ways to increase access, coverage, and patient care while reducing costs, according to the panel. Here are 8 ways they proposed to continue to stay on top of modern trends in U.S. health care legislation:

  1. Medicaid Waiver Process – Thirty-two states have expanded Medicaid through the ACA, signifying a shift in decisions falling to the state. This brings up budgetary issues for the states’ ability to handle large-scale reform, but there are a number of innovative solutions without having to deal with regulatory barriers, according to the panel. With correct design and the right players within the Medicaid program, expansion dollars can be applied effectively in areas such as digital, genomic, and population health management.
  2. Market Stabilization – One major effect of Trump’s executive orders is a requirement for administration to look at ways to weaken the marketplace, and changes have been made. Funding for the marketplace has been cut by 90 percent, which creates a drastic need to respond with short term solutions to stabilize the marketplace.
  3. Patient Need – Pharmaceutical companies often deal with very small patient populations due to the specificity of most drugs in development. This creates an urge for companies to develop relationships with patients to invest in creating products that effectively serve patient need. Additionally, research by Aurora showed a 60% reduction in utilization of the emergency department when patients needs were met beyond medical healthcare. With efforts to increase coverage, it’s more important than ever to
  4. Bending Cost Curve – From a policy perspective, it’s necessary to move away from a free-for-service system and create incentive to keep people well. With unpredictable premium pricing and confusing insurance coverage options, it’s more important than ever to lower the cost curve for all patients. Value-based purchasing needs to become a major focus for larger members looking at creating a system that works.
  5. Drug Pricing – A recent push to require manufacturer price transparency in a number of states targeted the staggering number of pharm products that cost more than they should, but the result was underwhelming due to the public’s unwillingness to review complex pharmaceutical price data. “It sounds good on paper, but in reality doesn’t work,” said Plues. Instead, legislation was passed to allow pharmacists to substitute lower-cost “biosimilar” products to customers, which has a real, drastic effect on patient cost.
  6. Big Data – With more than 12 billion devices attached to the internet, opportunities for growth based on collaboration far outweigh the market advantage of competition and withheld information. Correct utilization of data can create mindboggling savings for states across the country. Biotech companies need to be talking to payers, and healthcare systems need to be talking to patients. No one is going to solve the cost curve problem alone.

To learn more about U.S. Legislation, visit The Henry J. Kaiser Family Foundation website which provides information, news, polling, and other resources for health care consumers. For more recap blogs and videos, visit our past Summit page here!