Senate repeal-and-replace bill could improve on imaging-related policy

The U.S. House of Representatives passed the controversial American Health Care Act (AHCA) by a narrow vote, but any and all parts of the bill are up for debate in the Senate—including the provision allowing states to waive requirements for essential health benefits such as preventative screening.

While any reduction in access to care is a net negative for the industry as a whole, radiology is especially sensitive to legislation surrounding essential health benefits. Breast screening increased when the Affordable Care Act (ACA) removed financial barriers to preventative exams. Removing coverage of preventative care could reverse that trend, according to a study published in the American Cancer Society’s journal Cancer.

However, radiologists shouldn’t panic: The Senate will likely need 60 votes to pass a bill allowing states to waive essential health benefits because of a legislative statute called the Byrd Rule, according to Cynthia Moran, Executive Vice-President Government Relations, Economics & Health Policy at the American College of Radiology.

The Byrd rule determines what can or can’t be passed through budget reconciliation, a way to pass legislation with 51 votes rather than the 60 normally required in the Senate. The rule stipulates legislation going through budget reconciliation must directly affect the budget or deficit, but Moran believes essential health benefits are too far removed from monetary policy to qualify.

Thankfully, the Senate may not get that far. They could choose not to introduce the House bill and instead write their own, as Lamar Alexander, R-Tennessee, chair of the Senate health committee, has suggested. This could torpedo the essential health benefits waiver from the start, said Moran.

“If they start from scratch I think it would be very difficult to think the Senate would allow states to waive essential health benefits,” said Moran.

Further complicating the repeal-and-replace effort is the rest of the GOP agenda, with sights set on tax reform. While the Senate could take the rest of the year to work on the AHCA, Moran believes they will move more quickly.

“What’s looming over everybody is the desire to move forward on tax reform,” she said. “I think that is going to speed up the timetable of trying to get a consensus developed on the American Health Care Act.”

At the end of the day, whatever the Senate produces will have to keep the more conservative members of the House in mind, making the final bill unpredictable as of yet, according to Moran.

“This is going to be legislative engineering at its best,” she said. “Leaders of the Senate are going to have to come up with a policy that can pass a much more moderate policymaking body in the Senate, knowing it will ultimately have to go back to the House.”