A major milestone was reached in the Senate on Monday after the Senate voted 99-1 to pass bipartisan legislation to combat the opioid epidemic through new research, treatment and family resources. More than 70 provisions are included in the package, which must be reconciled with legislation that passed the House in June in order to become law. The $8.4 billion legislative package received nearly unanimous support, with only Senator Mike Lee (R-UT) voting in opposition, citing a lack of accountability for some spending measures. The House version likewise received overwhelming support, passing by a vote of 396-14, with most defections also coming from the more conservative Republican Freedom Caucus members.According to the Department of Health and Human Services, one in three Medicare recipients who use the Part D prescription plan received a prescription opioid in 2017. Data released by the Centers for Disease Control and Prevention also cited more than 72,000 overdose related deaths in 2017, a 10% increase from the previous year. The Senate’s package is ambitious in scope, as combating the epidemic has been a vexing issue for policymakers in recent years, as they have attempted to direct resources throughout the country with little traction to this point.
NAHU has been closely monitoring the legislation as it relates to the end-stage renal disease (ESRD) provision included in the House-passed version of the opioids bill that could add an additional $46,000 per patient to employer costs. The provision calls for extending the amount of time that employer-sponsored plans must cover treatments of kidney disease for ESRD by three months before Medicare becomes the primary payer. This would significantly shift costs to employers and potentially to patients who may face balance billing for these treatments. And as these costs are shifted, the plans will become increasingly unaffordable for workers, their families, and retirees.
In response to the Senate’s passage of the legislation, NAHU joined the National Coalition on Benefits in sending a letter this week to legislators urging them to oppose the House-passed ESRD financing measures. We advocated for omitting that provision from the final legislative package as it would not only not help in combating the opioid crisis, but it would also cost employers significant resources that could be directed towards providing other health insurance benefits including existing mitigation programs, and could threaten coverage that currently enrolls more than 180 million Americans.
House and Senate leaders are in the process of negotiating a final package with the goal of advancing it to President Trump before the November elections. As the House is currently scheduled to go into recess on October 12, and possibly sooner, Congressional leadership will need to move quickly with the House voting as soon as next week and the Senate the following week. In addition to the ESRD funding, other areas of contention that will need to be resolved include patient privacy issues, payments for use of certain inpatient facilities, Medicare coverage for non-opioid alternatives, and treatment for Medicare coverage of methadone addiction.