SIIA Legislative Update: Year-End Deal Includes Important Health Care Provisions

SIIA Commends Repeal of Healthcare Taxes, Urges Action on Surprise Billing

Over the course of 2019, the Self-Insurance Institute of America, Inc. (SIIA) has been at the forefront of various healthcare debates in Congress, including surprise billing, increased transparency of medical prices and quality of care issues.

Yesterday, congressional leadership announced an agreement on a year-end spending package that tackles a number of important health care-related issues. While SIIA appreciates congressional passage of much needed relief from healthcare tax burdens, work must continue in order to provide a fair solution to onerous surprise bills for self-insured workers and their families.

Full Repeal of Healthcare Taxes

The year-end spending package, expected to pass Congress later this week, includes a full repeal of both the Cadillac Tax (a 40% tax on employer health plans that exceed specified dollar thresholds), and the excise tax on health insurance companies, which also impacts self-insured multiple employer welfare arrangements (commonly referred to as the “HIT Tax”).

In year’s past, Congress has merely delayed these taxes. However, the year-end spending package calls for full repeal. SIIA has been a strong and vocal advocate for full repeal of these taxes, joining with over 1,000 employers and other coalition partners in supporting such action.

The year-end package bill will also increase the age to purchase tobacco products to 21 and repeal the Medical Device Tax. The various tax repeals will be temporarily paid for through the CREATES Act, which will make it easier for generic drug companies to obtain brand-name drug samples towards the creation and development of competing generic and biosimilar products.

Surprise Billing Tabled

Importantly, this year-end package bumps several expiring Medicare/ Medicaid provisions to May 22, 2020, at which point congressional leadership hopes to take up a health transparency package that will include surprise billing and drug pricing provisions. Such provisions will serve as long-term “pay-fors” on the expiring provisions. There are both opportunities and concerns with this approach, particularly that these policy decisions will be pushed to the midst of primary season in an election year.

For much of the past year, SIIA has been heavily engaged in the surprise billing debate, both as an association and as part of a larger employer coalition. While this debate started off as a fairly straightforward task of protecting patients from surprise billing in the case of emergency room and out-of-network services, it has become mired down on the subject of appropriate reimbursement mechanisms for such care. Throughout this debate, SIIA has held over 200 meetings in the House and Senate, and multiple meetings with leadership offices and committee staff. In addition, SIIA’s Government Relations Committee has provided guidance and feedback on the association’s approach and efforts, with an understanding that Congress would need to compromise between a benchmark and arbitration approach in order to come to a viable solution.

SIIA has strongly advocated for a benchmark reimbursement rate that was approved by the Senate HELP Committee earlier this year as part of S. 1895, the Lower Health Care Costs Act. This benchmark rate is a private-sector approach based on in-network median rates linked to geographic areas.

In contrast, provider groups, hospitals and private equity groups have been strongly pushing for an independent dispute resolution process for disputed bills, or a baseball style arbitration approach. This baseball-style arbitration is a winner take all approach, whereby each side submits a best and final offer to an arbiter, who then chooses one or the other, while considering multiple factors, including regional median rates, among other things.

Within the past week, Senate HELP and House Energy & Commerce sought a compromise approach between benchmarking and arbitration, which became stalled by a last-minute House Ways and Means that sought to delay consideration.

SIIA continues to strongly believe that an equitable and fair solution to prevent patient’s from receiving surprise bills must be found, and we will continue to have ongoing dialogue and meetings with policymakers.

With this important issue continuing into 2020, SIIA and its members will remain engaged and be prepared to continue our long-term advocacy on surprise billing and policy actions that bring transparency and accountability to the rising cost of healthcare.

To learn more about this and other policy developments, please plan on attending the legislation/regulatory session featured as part of SIIA’s upcoming Self-Insured Health Plan Executive Forum, scheduled for March 16-18, 2020 in Charleston, SC. Event details can be accessed on-line at

Should you like to discuss the year-end spending package in more detail, or have questions, please contact Ryan Work, SIIA vice president of federal government relations, at