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Congressman Adrian Smith

Representing the 3rd District of Nebraska

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Improving Health Care

July 22, 2019
Column

One of my top priorities is improving health care for rural Americans. Access to high quality, affordable, and available heath care is increasingly lacking in many areas. Empowering providers to better meet the needs of patients and reducing costly and burdensome regulations can go a long way to streamline and strengthen our health care system.

 

Recently, the Committee on Ways and Means approved a bipartisan package of health care bills, including two bills I sponsored. The first, H.R. 3431, postpones implementation of “direct supervision” – requiring a physician be physically present – for outpatient therapeutic services at rural hospitals until 2021. Every time I visit one of the 55 Critical Access Hospitals in the Third District, providers tell me of the consequences of this burdensome regulation. My legislation provides relief for rural providers and allows them to meet the needs of their patients without arbitrary restrictions.

 

The second bill, Keeping Physicians Serving Patients Act (H.R. 3345), also helps rural providers and patients. In order to adjust payments to physicians regionally based on their costs of practicing medicine, Medicare uses a formula called the geographic practice cost index (GPCI). However, this formula can unintentionally harm rural providers because lower costs of operating results in significantly lower Medicare payments. H.R. 3345 protects these providers by extending minimum GPCI standards for three years.

 

Additional developments in health care policy have been encouraging as well. In the nine years since Obamacare was enacted, one provision, the “Cadillac Tax,” has become increasingly unpopular. After twice being delayed, the “Cadillac Tax” – a 40 percent excise tax on high-cost employer health care plans – is set to take effect in 2022. This tax would have market-wide impacts, reducing the health care benefits offered by employers and increasing the tax burden on employees.

 

On July 17, the House passed H.R. 748, which repeals the “Cadillac Tax.” I am a proud cosponsor of this legislation, and was glad to see such bipartisan support when it passed by a vote of 419-6. 

 

I am also working on legislation to implement commonsense guardrails for the Center for Medicare and Medicaid Innovation (CMMI). CMMI was created by Obamacare to rapidly test new models involving payment or patient care to lower costs or improve patient outcomes. CMMI was given overly broad exemptions from existing regulations and judicial review allowing these models to make sweeping changes without any Congressional oversight. 

 

For example, under the Obama administration CMMI proposed a broad across the board cut to reimbursements for prescription drugs administered by health providers in outpatient settings. This so-called “pilot” would have impacted 75 percent of Medicare beneficiaries without Congressional oversight. The guardrails for CMMI will ensure new models are appropriately limited in size and scope, and to reassert Congressional approval in model expansion. 

 

The American people are expecting fixes to health care, and these recent bipartisan efforts are an encouraging sign. We still have ways to go on health care, but it is my goal to provide a better health care system for our nation, and I will continue to work toward this goal.

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