Congress Passes Short-Term Spending Bill and Punts Important Health Care Priorities Until May 2020

From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple, MD, FACG

This week, Congress passed a $1.4 trillion spending deal before federal funding ran out on Friday, December 19th. Of note to ACG members, the Labor-HHS portion of the package includes $94.4 billion in discretionary funding for the Department of Health and Human Services (HHS), an increase of $4.4 billion. This includes an increase of $2.6 billion for the National Institutes of Health (NIH). The package provides $5.7 billion over two years of Medicaid funding (FY 2021 and 2022) for Puerto Rico and other U.S. territories, changed from the $12 billion over four years that Republican and Democratic leaders agreed to earlier in the week. Various health care programs were temporarily extended to May 2020.

What about ACG’s legislative priorities?
Of note, the Labor-HHS spending bill did include language saying:
“Colorectal Cancer Screenings: The agreement encourages CMS to use its existing authority to increase access to colorectal cancer screenings by exploring options to reduce out-of-pocket costs associated with screening colonoscopies when a polyp or lesion is found and removed.”

This language is helpful in our momentum and advocacy but more needs to be done.

Congress targets May 2020
In short, though, Congress decided to punt major health care priorities until May 2020 in order to pass these short-term appropriations packages. This includes ACG priorities such as:

The Removing Barriers to Colorectal Cancer Screening Act (S. 668; H.R. 1570): As ACG noted last week, the U.S. House passed a larger drug pricing bill that included H.R. 1570 in the package. Thank you ACG members for all of your advocacy. The Senate, however, ultimately decided not to take-up the measure. It is important to note that H.R. 1570 was included in both the Democratic package that passed the House, and also in the Republican alternative package that failed to pass. While ACG continues to be frustrated over Congress not passing this overwhelmingly bipartisan bill, the College will use this time to generate congressional leadership support for inclusion in any healthcare legislative package in the spring of 2020. Also, please note that the bill does NOT have to be reintroduced in 2020.

“Surprise” medical bills: ACG made significant efforts in advocating for Congress to pass legislation that adequately reimburses ACG members when treating out-of-network patients, including using state models incorporating independent dispute resolution options, as well as using commercial reimbursement rates as any preset benchmark for negotiation. ACG also was very active reminding Congress that the Removing Barriers to Colorectal Cancer Screening Act resolves one example of a “surprise” bill: when a Medicare beneficiary receives a surprise medical bill after undergoing a screening colonoscopy at “no patient cost-sharing,” but a polyp was removed during the procedure (the intended purpose of the procedure). U.S. House and Senate committees continue to struggle to find common ground on this issue. ACG is also working with Congress on this important issue heading into 2020.

Lowering Drug Costs: Last week the U.S. House passed Speaker Nancy Pelosi’s drug pricing negotiation bill (H.R. 3). Meanwhile, the Senate Finance Committee leaders unveiled a new version of its drug pricing bill, S. 2543, but is having trouble garnering support among some Republicans, almost all Democrats, as well as the Trump administration. There is much work to be done on this issue as well.

ACG appreciates of your advocacy efforts. Your voices are heard. There is a lot of positive momentum heading into 2020.

ACA Back in the Courts: Appellate Court Rules "Individual Mandate" Unconstitutional

A federal appeals court on Wednesday struck down the ACA’s “individual mandate,” or provision requiring individual to purchase health insurance or be subject to a penalty. However, the court did remand this case back to a federal district court judge in Texas to reconsider how much of the ACA can survive without the “individual mandate” and whether this ruling could apply to only the Republican-led states who are the plaintiffs. In December 2018, a U.S. District Court in Texas concluded that the entire ACA was unconstitutional because Congress repealed the “individual mandate” in 2017.

How did we get here?
As ACG alerted membership in July, U.S. Circuit Court of Appeals in New Orleans heard arguments on whether the Patient Protection and Affordable Care Act (now known as the “ACA”) is constitutional. The lawsuit was brought by 18 Republican-led states, alleging that Congress' decision to zero-out (but not repeal) the “individual mandate” penalty in 2017 rendered the entire ACA unconstitutional. This argument stems from the U.S. Supreme Court’s decision in 2012 to uphold the ACA as a valid exercise of Congress’ taxing power, but also that that this individual mandate intrinsically links the other parts of the ACA. Twenty Democratic-led states have led the legal defense against this ACA lawsuit. The House of Representatives also joined the lawsuit in 2019, after Democrats won back control of the U.S. House in November 2018.

Gets more complicated: Mental Gymnastics
The Tax Cuts and Jobs Act of 2017 effectively eliminated the individual mandate. However, it only zeroed out the penalty beginning in 2019. So, the 2017 law may not have actually repealed this provision; rather just changed the penalty amount. The Justice Department (DOJ) in June 2018 chose not to defend the ACA in this case. This Justice Department letter also noted that it agrees with the Justice Department under President Obama’s conclusion — that guaranteed issue for those with pre-existing conditions and community rate-setting should be tied to or inseverable with the individual mandate. Thus, the entire ACA was struck down.

ACG will continue to fight for important patient protections
The court’s ruling may have a significant impact on important ACG policy priorities, such as coverage protections for pre-existing conditions and eliminating cost-sharing for preventive care.

Reminder: CMS Open Payments System Deadline for Review and Dispute is December 31, 2019

As a courtesy to ACG Members, the College is alerting you to the December 31st deadline set by CMS to review Open Payments System data for the Program Year 2018.

While ACG has reservations about this system due to concerns over its accuracy and validity, the data is publicly available, and ACG wants you to be aware of the deadline and have the opportunity to verify your information.

Below is a recent email communication from CMS about this deadline:

From CMS: Review and Dispute Reminder

Program Year 2018 Open Payments data is available for review and dispute through December 31, 2019.

On June 28, 2019 the Centers for Medicare & Medicaid Services (CMS) published Program Year 2018 Open Payments data along with updated and newly submitted data from previous program years (2013-2017). Program Year 2018 data and newly submitted payment records are actively available for review and dispute through December 31, 2019. Learn more about reviewing and disputing public data.

Review Now

Physician and teaching hospital review of the data is voluntary, but strongly encouraged. If you have not previously reviewed the Program Year 2018 data visit to review the publically available data.

If you believe any records attributed to you are inaccurate or incorrect in any way you may initiate a dispute and work with the reporting entity to reach a resolution. CMS does not mediate disputes.

For more information on the review, dispute and correction process visit the Open Payments resource page at:

Questions – Contact Live Help Desk

Submit questions to the Help Desk via email at or by calling 1-855-326-8366 (TTY Line: 1-844-649-2766), Monday through Friday, from 9:00 a.m. to 5:00 p.m. (ET), excluding Federal holidays.

The Help Desk refers media inquiries to CMS’ Press Office for response.

Visit the Resources page on the Open Payments website for many of the above resources:

A Message From Practice Management Committee Chair Dr. Louis J. Wilson, MD, FACG

No matter what practice setting they are in, doctors cannot avoid taking responsibility for improving their practice.

Watch as Dr. Wilson invites you to explore the Practice Management Toolbox, a series of highly relevant articles that will improve your practice written by your ACG colleagues on the Practice Management Committee.