| |  | The Lead Brief | Lawmakers are ramping up discussions on how to tackle health care costs ahead of a promised vote in the Senate on yet-to-be-determined legislation from Democrats to address the expiring enhanced Affordable Care Act tax credits in December Congressional staffers and lobbyists have so far been saying that nothing concrete has come together, but the current public proposals are trending in opposing directions: altering the enhanced tax credits or scrapping them in exchange for an expansion of health savings accounts. - When it comes to extending the enhanced Affordable Care Act tax credits, some members have suggested implementing income caps to limit who can receive them and there’s also a bipartisan measure would use reforms to Medicare Advantage billing practices to pay for a two-year extension.
Both would be a tough sell. Republicans are demanding more guardrails on the enhanced tax credits and the insurance industry would mobilize against any changes to Medicare Advantage — a potentially toxic prospect going into the midterms. Senate Majority Leader John Thune (R-South Dakota) said there’s a bipartisan working group trying to find a compromise on the enhanced tax credits — which are broadly unpopular among House Republicans. At the same time, he also told reporters on Monday that GOP Sens. Mike Crapo (Idaho), who leads the finance panel; Bill Cassidy (Louisiana), who leads the health panel; and Roger Marshall (Kansas) and Rick Scott (Florida) are the main players to watch on legislation meant to address health care costs. - A proposal that has seemingly been gaining some traction — endorsed by President Donald Trump over the weekend — has been to give money directly to patients in health accounts, rather than to insurers. People couldn’t use the money to pay for their monthly insurance premiums, but it would pay for out of pocket health expenses such as doctors’ visits and medications.
Marshall has been advocating for health savings accounts, or HSAs, that are used by people with high-deductible health plans; Cassidy, who has previously supported expanding HSAs, is exploring whether to expand the use of FSAs, or flexible spending accounts, that are typically tied to employer-based health plans. He hasn’t written a formal proposal yet, however. Sen. Maria Cantwell, a Democrat from Washington, said on the Senate floor this weekend that Cassidy’s idea “has merit,” signaling an openness to engage in talks around the policy. → The Center for Budget and Policy Priorities, a left-of-center think tank, released a report this morning pushing back on the policy proposals, saying the health savings accounts wouldn’t lower insurance costs for the millions of people with Affordable Care Act plans. Some health industry analysts, including Chris Meekins at Raymond James, argue that there is not “broad buy-in” across the Republican conference. “When these types of major changes are considered, there usually needs to be time to socialize the idea to get members comfortable. There is just not time between now and year-end,” Meekins wrote in a note to investors on Tuesday. “We do not think Democrats are likely to be supportive of the more aggressive proposals Republicans may put forward.” → But there’s a new group of academics, medical professionals and policy experts that wants to raise awareness of the concept in an effort to help it gain traction. FIRST IN HEALTH BRIEF: The group, called Fund the Patient, says it aims to “disrupt today’s health care system” by directing cash straight to patients through vehicles such as health savings accounts, instead of going through government programs or insurance companies. “President Trump’s comments on social [media] over the weekend were spot-on — we need to fund patients rather than our broken healthcare system,” spokesman James Davis said in a statement. “We will leverage all tactics available to build support for this effort and improve healthcare outcomes in America.” The group is being advised by Anthony DiGiorgio, a professor of neurosurgery at the University of California San Francisco, and Terry Wilcox, the co-founder of advocacy group Patients Rising. “Patients get healthier and spend less when they can directly and personally benefit from better health and lower prices,” said Ge Bai, another advisory board member for the group and a professor of accounting and health policy at Johns Hopkins. “Government regulations like those in the Affordable Care Act detach patients from their healthcare dollars, causing unaffordability and restricting access.” | 
_tstmp_1756933376-1920-1080.png)
