EP469 (Part 2): The Impact on Plan Sponsors of Medicare Site-Neutral Payments and HSA Reforms, With James Gelfand, JD

Did you just listen to the show with James Gelfand on the impact of Medicaid cuts on plan sponsors, what the cuts actually are, and what the intriguingly named “Cornhusker Kickback“ is all about? If not, no worries. But do go back and listen to that after you listen to this show. No particular order of listening is superior for this double episode, so it’s all good no matter how you have chosen to roll.

For a full transcript of this episode, click here.

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Now, in this show that you are currently listening to, one part of the episode 469 double episode, this is what’s gonna happen. I ask my guest today, James Gelfand, to get into the what and how and so what of the goings-on with Medicare site-neutral payments and honest billing practices. And then I ask him the same thing with the HSA (health savings account) reforms currently in Congress.

And look, bottom line, I was a picture of overconfidence walking into this conversation. Relative to the Medicare site-neutral payments, James has some crisp feedback for plan sponsors, which is, in a nutshell: Get ahead of this, and TPAs (third-party administrators) and consultants and brokers should be all over this right now, advising clients and writing stuff into provider contracts.

Then, after we cover Medicare site-neutral payments, we very seamlessly, if I do say so myself, segue into what’s the what with HSAs, health savings account reforms.

I did not realize a few things here. One of them is that HSAs last were taken up by Congress in 2003, back in those halcyon days of high-deductible health plans (HDHPs) or, even better, consumer high-deductible health plans (CHDHPs), when we all kind of thought—including me, by the way (wow, did I change my tune)—but the prevailing wisdom was that giving patients and members skin in the game would evoke high-value purchasing decisions by them. And yeah, listen to me going off on why that is not really true and the moral hazard of insurance for 20 minutes in an inbetweenisode (INBW41).

So anyway, first up we talk about Medicare site-neutral payments and honest billing practices, then the current issues with the current HSA regs and what the future may hold.

And, just saying, lest anyone forget, the current HSA regulations really hinder plan sponsors’ ability to offer, like, direct primary care and pay for it or do stuff to help members with chronic conditions keep those conditions managed.

There are many not super intuitive but really impactful issues here.

Now, of course, hospitals do, in fact, come up on this show; and I am seeing this in a bunch of intros lately. But let me remind everyone, it so must be said with five underlines, all hospitals are not the same, and what a hospital does or doesn’t do may not be the same as what many or most who work at the hospital believe is the right thing to be doing.

Listen to the show with Komal Bajaj, MD (EP458) on just the gaping disconnects and lack of trust between clinicians and administrators—some of them, not all, of course. Also, a hospital can be doing great things and really crappy things absolutely simultaneously. These are big, sprawling places with a lot going on.

James Gelfand, as aforementioned, my guest today, is president and CEO of The ERISA Industry Committee, otherwise known as ERIC. ERIC represents the nation’s largest self-insured employers advocating for comprehensive benefits and healthcare policies that impact millions of employees across the country.

James Gelfand brings nearly two decades of experience in healthcare advocacy, having worked at the Chamber of Commerce and on Capitol Hill.

When you are done listening to the show, please do come back and take a listen to the other part of this double episode if you haven’t already. In that part, we talk Medicaid cuts and the impact on plan sponsors and etcetera.

I also talk about how James Gelfand came to find himself invited on the pod to begin with. And short version, it all started with Cora Opsahl. And I say this as a thank you to Cora because these shows with James Gelfand are so informative, and he was, in fact, the exact right person to have these conversations with.

Also mentioned in this episode are The ERISA Industry Committee; Komal Bajaj, MD; Cora Opsahl; Christine Hale, MD, MBA; Erik Davis; Autumn Yongchu; and Shawn Gremminger. 

You can learn more at The ERISA Industry Committee and by following James on LinkedIn. 

James Gelfand, JD, became president and CEO of The ERISA Industry Committee (ERIC) in April 2023, having previously served as its senior and then executive vice president for eight years. He was promoted to the position of president in June 2022.

James oversees all aspects of the association’s activities, which focus on programs that shape federal and state health and retirement benefit policies and that impact ERIC member companies’ ability to operate under federal ERISA protection from a patchwork of conflicting state and local laws. He has brought prominence to ERIC among federal and state lawmakers, thought leaders, and major companies in the United States and globally. James provides strategic leadership to ERIC’s legislative, regulatory, and legal advocacy; membership and partnerships; and communications and operations to achieve ERIC’s mission and implement the directives of ERIC’s board of directors.

James has been recognized as a top industry lobbyist by both the National Institute for Lobbying & Ethics and The Hill. Since 2018, he has served on the board of directors and executive committee of the Arlington, Virginia–based Maternal Mental Health Leadership Alliance (MMHLA). MMHLA is a nonpartisan, nonprofit organization dedicated to promoting the mental health of mothers in the United States, with a focus on national policy and health equity. MMHLA is a staunch advocate for improved mental healthcare during pregnancy and postpartum.

James earned his JD at George Washington University Law School in Washington, DC, and his undergraduate degrees in political science and legal studies at Northwestern University in Evanston, Illinois.

05:42 What does Medicare site-neutral payments mean?

08:59 How do markups play into the dynamics here?

09:52 Upcoming episode with Christine Hale, MD, MBA.

10:36 What does the “narrow” start for these changes mean?

11:42 What action steps should plan sponsors be taking?

13:01 What options do plan sponsors have in highly consolidated markets?

14:27 EP371 with Erik Davis and Autumn Yongchu.

14:53 EP448 (Part 1 and Part 2) with Shawn Gremminger.

15:46 Will this bill potentially make changes to HSA plans?

17:40 Why has the thinking behind healthcare usage changed since the inception of HSAs?

18:42 INBW41 with Stacey.

23:24 How are preventive care and first-dollar coverage connected within the context of HSAs?

25:48 Why would it be difficult to completely get rid of a high-deductible health plan and offer HSAs without them? 

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis, Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42), Chris Crawford (EP461)