A soon-to-be-divided federal government will offer partisans plenty to argue about. Democrats will hold a narrow Senate majority, and Republicans are set to control the House by a slender margin, which would seem like a recipe for legislative gridlock.
But bipartisan cooperation is possible, and even likely, in the 118th Congress in the healthcare realm on efforts to expand the ability of patients to connect with doctors without an in-person visit. Telehealth was already a growth industry before the COVID-19 pandemic and one that accelerated greatly during the coronavirus era amid the practice of social distancing.
Lawmakers from across the ideological spectrum say it’s important to increase access and affordability for virtual services. Telehealth legislation, including adding access for Medicare beneficiaries, may even be considered in the lame-duck session of Congress during the waning days of the Democrats’ control of the House.
The topic will likely get more exposure once the new Congress convenes on Jan. 3.
“I think when it comes to health policy, there are some areas that they can come together and look forward in trying to find solutions for. Some of that is going to be around telehealth reimbursement. That is a bipartisan issue,” said Michael P. Strazzella, the head of federal government relations at Buchanan Ingersoll and Rooney.
A bill sponsored by Rep. Liz Cheney (R-WY) passed the House earlier this summer 416-12, if Congress decides to tuck it into government spending legislation during the lame-duck period.
Cheney’s Advancing Telehealth Beyond COVID-19 Act of 2021 would extend certain flexibilities that were granted under the COVID-19 public health emergency. The proposal would enable Medicare to reimburse for telehealth services until Dec. 31, 2024, regardless of whether the emergency period expires before then. Prior to the pandemic, Medicare only paid for telehealth care in limited circumstances and only then allowed video visits, not audio-only calls between a patient and provider.
The bill would build on an extension that Congress approved earlier this year, guaranteeing five months of Medicare coverage of audiovisual and audio-only services once the public health emergency declaration ends for COVID-19. Its enactment would be a last legislative hurrah, of sorts, for Cheney. The onetime House Republican Conference chairwoman lost her House seat in the August GOP primary over sustained criticism of former President Donald Trump and related matters.
Other pieces of proposed legislation aim to increase access to telehealth services for people on employer-sponsored plans. The Telehealth Expansion Act of 2021, introduced by Reps. Michelle Steel (R-CA) and Susie Lee (D-NV), would make a provision of the CARES Act permanent. The proposal would allow high-deductible plans, paired with tax-friendly health savings accounts, to cover telehealth care before the out-of-pocket payment threshold is met.
Previously, these health plans were not permitted to cover telehealth services, including physical and mental health services, until after the deductible was reached.
A companion bill was also introduced in the Senate by Sens. Steve Daines (R-MT) and Catherine Cortez Masto (D-NV). Their across-the-aisle legislative teamwork on telehealth reflects the issue’s broad popularity. After all, Daines just became the head of the Senate Republicans’ campaign arm for the 2024 cycle, while Cortez Masto survived a blistering Republican onslaught to win a second term representing Nevada in the Senate.
Without congressional action, the telehealth exemption for these health plans is set to expire at the end of this year. Over 350 employers, healthcare companies, and other stakeholders urged Congress earlier this month to prioritize extending this flexibility.
“More Americans need access to affordable mental and behavioral health services, not less,” read the letter to congressional leaders. “Without an extension of current flexibility, employers would be required to charge employees more to access this care, creating another barrier to treatment.”
Strazzella said that while short-term telehealth solutions might go through during the lame-duck period, he expects Congress to wait until more distant deadlines, such as the end of the public health emergency declaration, before considering more permanent legislative solutions to safeguard access to telehealth services.
“I think you will have providers and patient groups starting day one, Jan. 3, clamoring that something needs to be addressed, and in true fashion of Congress, depending on when that extension expires, we’ll see it shortly before that. There will be conversations before then, but nobody will get serious until the extension is about to expire,” Strazzella said.