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Health Policy Through a Crystal Ball: What We’re Tracking in 2022

January 19, 2022 |  By Sarabeth Zemel, JD

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Although COVID-19 continued to dominate the health policy and public health sphere in 2021, there was plenty of other exciting health policy news that will continue to make waves in 2022. This blog provides a high-level summary of what we are following from federal and state agencies, such as the Centers for Medicare and Medicaid Services (CMS) and others.

Federal Initiatives We’re Following:

  • Health equity as a CMS priority – CMS laid out its early vision for health equity in Medicaid, including a focus on data collection, and just recently set its vision for the Medicare program. The CMS Innovation Center has also set a new strategic direction that incorporates advancing health equity, including focusing new alternative payment models (APMs) on underserved populations and Medicaid-focused providers.
    • In a recent rule on Health Insurance Marketplace policy, CMS proposed several provisions to advance health equity including scaling back the documentation that must be verified when a consumer enrolls during a special enrollment period, because it disproportionately negatively impacts Black consumers. CMS also proposed increasing the number of “essential community providers” which predominately serve low-income and medically underserved communities and we expect CMS and CMMI to continue to put forth new policies focused on health equity in 2022.
  • Surprise billing goes into effect – Studies indicate that 1 in every 5 visits to the emergency room results in at least one surprise bill and surprise billing increases premiums by about $40 billion a year. While some states, like California, had already enacted laws to prevent surprise billing, in late 2020, Congress passed federal legislation that restricts private insurance patients from receiving unexpected bills for emergency care, non-emergency department care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. The legislation also requires doctors and hospitals to provide good faith estimates of expected charges in advance for uninsured patients. Over the last 12 months, CMS has promulgated regulations to enact the new rules, and although several lawsuits have been filed over how CMS has implemented the rules, most provisions went into effect January 1, 2022.
  • Climate change implications on health policy – 2021 was a year of climate events, from extreme summer wildfires across the Western states to more recent tornadoes in the Midwest. The federal level action includes:
  • Still in negotiations…At the time of this blog post’s publication, the $1.75 trillion Build Back Better Act was still in negotiations, although if passed, it is poised to be the biggest social policy bill of our lifetime. While its fate is extremely uncertain due to Senator Manchin (D-WV) pulling his support from the bill, if Congress and Manchin can come to an agreement, among its many provisions, it would expand Medicaid in the 12 states that have not adopted the Affordable Care Act’s Medicaid expansion and allow CMS to negotiate on price for Medicare Part B prescription drugs, an important policy lever for reducing rising drug prices.
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State-Based Initiatives We’re Following:

  • Universal health care in California – The California Legislature convened last week and Democrats in the Assembly released a proposal seeking to establish a single-payer health care system funded through an excise tax and payroll taxes. This week, Gov. Gavin Newsom unveiled his proposed 2022-23 budget, which includes a proposal to extend Medi-Cal coverage to undocumented immigrants between the ages of 26 and 49, the biggest population in the state currently left out of health coverage. Meanwhile, the Healthy California for All Commission is tasked with developing policy recommendations for moving to universal coverage for all, and specifically 
    developing a plan for a state health care system with unified financing, including examining a single payer system. After two years of meetings, the Commission’s work is nearly complete and its draft final report is expected to be out at the end of the month. It will be important to watch how these efforts advance as the legislative session continues.
  • CalAIM implementation – The California Advancing and Innovating Medi-Cal (CalAIM) initiative is poised to transform California’s Medi-Cal program for the long-term, and is the driver for investments in social determinants of health that will expand statewide under the initiative. Two of the most important components of CalAIM began on January 1 – Enhanced Care Management and Community Supports. Enhanced Care Management is a comprehensive care management program that addresses both clinical and non-clinical needs of high-cost, high-need Medi-Cal managed care members through coordination of community-based services. Community Supports are medically appropriate and cost-effective alternatives to services covered under Medi-Cal offered by Medi-Cal managed care plans and include non-traditional service categories such as housing navigation, meals, and asthma remediation. Together the programs help to manage the health care and social needs of the most vulnerable Medi-Cal enrollees. In the last week of 2021, CMS approved an 1115 and 1915(b) waiver giving California the approval to implement many of the changes proposed in the initiative and draw down federal Medicaid funding for them.
  • Oregon’s 1115 waiver application – The Oregon Health Authority drafted an 1115 waiver application that includes a number of proposed provisions intended to address health equity in Oregon’s Medicaid program. They have also proposed several unique ways to engage community members in these health equity measures. The waiver application is currently under the state’s 30-day comment period. Stay tuned for an upcoming blog where we’ll delve deeper into OR’s draft waiver application and examine the health equity and community engagement provisions in detail.
  • California’s Office of Health Care Affordability – For the last two years, Governor Newsom has proposed creating a new state Office of Health Care Affordability to reduce the rising costs in health care. Although authorizing legislation failed to pass during the last two legislative sessions, the Gavin Administration has advanced the proposal once again in the 2022-23 budget. While states like Oregon, Rhode Island, and others have established cost targets for health care spending, none of them have as big a health care budget as California. The Office would also increase transparency on health care spending in the state, as well as set goals for adopting alternative payment models in the state.
  • State action on climate change –
    • Oregon’s draft 1115 waiver application also proposes Medicaid benefits for those who are impacted by climate disasters and extreme weather events, including payment for transportation to cooling or evacuation shelters, payment for air conditioners, air filters and other related equipment, housing supports and services for damages due to wildfires, among others.
    • California Gov. Newsom’s 2022-23 budget proposal includes several initiatives to combat climate change impacts on public health, including a climate and health surveillance program, grants for local health jurisdictions to develop regional climate and health resilience plans, and developing a workforce of community health workers specializing in the area of climate health.

Transform Health will continue to track these issues and initiatives in 2022. Watch our blog for updates on these policies as the year progresses.

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