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Stephanie Pellitt

, National Council for Behavioral Health

What to Watch in Health Care in 2019

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The 116th Congress began on Thursday amid a government funding lapse that has shut down roughly 25 percent of the federal government. Democrats are set to lead the House chamber for the first time since 2010, while Republicans remain in control in the Senate. While legislation may be move less quickly in the new divided Congress, lawmakers will still face a number of “must-pass” bills that include health care priorities. Additionally, the Trump Administration will continue to shape the health care landscape with Medicaid waivers and potential payment reforms. Here is a preview of what’s ahead in health policy in 2019.

FY 2020 Budget: FY 2020 will see the return of scheduled funding cuts, known as “sequestration”, on non-defense discretionary spending, which includes health care programs. Established by the 2011 Budget Control Act, sequestration could result in major funding cuts to discretionary spending across the board. The National Council will be urging Congress to lift the caps to avoid harmful cuts to vital health programs. If Congress does not lift the caps this Spring, recent FY 2019 funding increases for mental health and addiction programs would be in danger of being lost.

ACA Legal Challenge: While attempts to “repeal and replace” the Affordable Care Act are likely dead with a Democratic-controlled House, the ACA now faces a new threat in the legal system. In late December, Judge Reed O’Connor found the Affordable Care Act (ACA) to be unconstitutional following Congress’ repeal of the individual mandate penalty in 2017. Legal experts are overwhelmingly skeptical that Judge O’Connor’s ruling will be upheld through the appeals process and during this time the ACA remains the law of the land. Nonetheless, the ruling injects a new round of uncertainty in the health insurance marketplace, and for the health care sector more generally. This will be an issue to watch closely in 2019. Read more about O’Connor’s decision here.

Medicaid Waivers: Since assuming office, Centers of Medicare and Medicaid Services (CMS) Administrator Seema Verma has promoted state-based control and flexibility over Medicaid programs and individual insurance marketplaces, largely through the use of waivers. Many of these new waivers, like Medicaid work requirements, are opposed by the National Council for restricting beneficiaries’ access to behavioral health services. CMS has also directed states on new pathways for bypassing the ACA. At the same time, CMS has released new opportunities for states to increase access to services, including their recent announcement about mental health services.

With a divided Congress, expect the Trump Administration to focus more energy on shaping health policy through waivers and other executive action. House Democrats may also use their new oversight authority to investigate the Trump Administration’s actions to undermine the ACA and implement work requirements.

More Opioid Legislation: Following the 2018 Opioid Package, some Democrats expressed concern that the package “did not go far enough” to address the ongoing opioid crisis. The package included a number of important provisions for providers that were the direct result of National Council advocacy, including: a new loan repayment program for addiction treatment professionals, behavioral health IT incentivizes, and expanded access to telemedicine. However, the National Council was disappointed that the package lacked meaningful, long-term investment in our nation’s addiction treatment system by not including an expansion of the Certified Community Behavioral Health Clinics (CCBHCs) program. The National Council remains hopeful that Congress will find bipartisan compromise once again and pass legislation to address the addiction crisis early on in the new year.

Payment Reform: The drive toward value-based payments will continue into 2019. Expect CMS to continuing pursing the alternative payment models that started under the Affordable Care Act including bundled payments and more accountable care organizations.