Congress Considers PBM Reform and Gig Worker Benefits Amid Health Policy Discussions

What's Happening?

Congress is preparing to address several health and retirement-related issues as it reconvenes in September. Key topics include potential reforms to pharmacy benefit managers (PBMs) and benefits for gig workers. The PBM reforms aim to increase transparency in business practices, ban 'spread pricing' in Medicaid, and separate drug prices from PBM compensation in Medicare. Additionally, Congress is considering bills to enhance benefits for independent contractors and gig workers, such as the Association Health Plans Act and the Independent Retirement Fairness Act. These proposals seek to decouple benefits from worker classification and promote portable benefits. The legislative agenda also includes discussions on extending enhanced tax subsidies for health coverage under the Affordable Care Act, which are set to expire at the end of the year.

Why It's Important?

The potential reforms to PBMs and gig worker benefits could significantly impact the healthcare and labor markets in the U.S. By increasing transparency and regulating PBM practices, the reforms aim to reduce drug costs and improve access to medications for consumers. For gig workers, the proposed legislation could provide greater access to health and retirement benefits, addressing a long-standing gap in the gig economy. These changes could lead to a more equitable distribution of benefits and potentially influence the classification of workers, affecting millions of Americans who rely on gig work for their livelihood. The outcome of these legislative efforts could reshape the healthcare landscape and labor market dynamics, with implications for employers, employees, and healthcare providers.

What's Next?

As Congress returns from recess, the focus will be on negotiating bipartisan support for these reforms. The funding bill required to keep the government operational may serve as a vehicle for passing healthcare reforms. Lawmakers will need to balance competing interests and priorities, particularly between extending ACA subsidies and implementing new health and labor policies. The success of these initiatives will depend on the ability of Congress to reach consensus and the willingness of stakeholders to adapt to new regulatory frameworks. The legislative process will likely involve extensive debate and amendments as policymakers seek to address the diverse needs of their constituents.