Affordability and the Healthcare Market

State of Play:  The administration has maintained that individuals who have lost insurance coverage due to the COVID-19 pandemic can enroll in the Affordable Care Act (ACA) health insurance marketplace under existing qualifying events, which include loss of health coverage or a significant change in income.  Under current regulations, Special Enrollment Periods (SEP) apply to people who lost their employer-based minimum essential coverage.  The Kaiser Family Foundation (KFF) released a tracking poll in February that found 55 percent of Americans have a favorable view of the ACA, the highest rating since the law was enacted.  The Supreme Court will take up Texas v. Azar to further examine the constitutionality of the individual mandate. Surprise medical billing legislation continues to be considered by both the U.S House of Representatives and the Senate.  New Mexico has a new law allowing for importation of drugs from Canada. The Centers for Medicare and Medicaid Services (CMS) has released the proposed annual Notice of Benefit and Payment Parameters Rule for 2021.  In particular, the rule proposes to expand its copay accumulator policy to let ACA plans exclude drug makers’ coupons from counting toward enrollees’ out-of-pocket maximums, even when there is no generic option available.

HLC Position:  HLC believes that all Americans should have access to affordable, high-quality healthcare.  Congress and the administration should bolster the stability of the health insurance marketplace, encourage greater competition, and provide all Americans enhanced choice in coverage by guaranteeing issuance of health insurance without preexisting condition, annual, or lifetime coverage limits, but in conjunction with continuous coverage requirements and other critical safeguards against adverse selection.  HLC supports improved risk adjustment mechanisms, continuous coverage requirements, and improved decision support tools for consumers.   Consumers can also be assisted through improved policies and payment methodologies for telemedicine.  HLC advocates for consumer-centered drug payment approaches and opposes tying drug prices to those of other countries that utilize price controls. 

HLC Recent Activity:

  • HLC continues to serve on the executive committee of the Partnership for America’s Health Care Future and the executive board of the Council for Affordable Health Coverage.
  • On January 8, HLC wrote the House Energy and Commerce (E&C) Committee expressing support for H.R. 2477, the “Beneficiary Enrollment Notification and Eligibility Simplification Act,” and H.R. 3935, the “Protecting Patients Transportation to Care Act.”
  • On December 10, HLC wrote the House Energy and Commerce (E&C) subcommittee on health in advance of its hearing on “Proposals to Achieve Universal Health Care Coverage.”
  • HLC continues to serve on the executive committee of the Partnership for America’s Health Care Future and the executive board of the Council for Affordable Health Coverage.
  • On September 26, HLC wrote the House Education and Labor (E&L) Committee in advance of its hearing on “Making Health Care More Affordable: Lowering Drug Prices and Increasing Transparency.”
  • On September 24, HLC joined a group letter to Senate and House leadership urging permanent repeal of the medical device tax. HLC Regional Directors also advocate on medical device tax and health insurance tax (HIT) in meetings with congressional members.
  • On September 11, HLC wrote a blog expressing concerns on prescription drug importation.
  • On June 6, HLC wrote the House Ways and Means Committee (W&M) in advance of its hearing on “Pathways to Universal Health Coverage.”
  • On June 5, HLC submitted comments in response to the Senate Health, Education, Labor, and Pensions (HELP) Chairman Lamar Alexander and Ranking Member Party Murray’s draft “Lower Health Care Costs Act.”
  • On June 4, HLC wrote the House Energy and Commerce (E&C) subcommittee on health in advance of its hearing on “Investing in America’s Health Care.”
  • On June 6, HLC wrote the House Ways and Means Committee (W&M) in advance of its hearing on “Pathways to Universal Health Coverage.”
  • On June 5, HLC submitted comments in response to the Senate Health, Education, Labor, and Pensions (HELP) Chairman Lamar Alexander and Ranking Member Party Murray’s draft “Lower Health Care Costs Act.”
  • On June 4, HLC wrote the House Energy and Commerce (E&C) subcommittee on health in advance of its hearing on “Investing in America’s Health Care.”
  • On May 6, HLC responded to a request for information from the Centers for Medicare and Medicaid Services (CMS) on the sale of individual health insurance coverage across state lines.
  • In April, HLC wrote U.S. Senators Pat Toomey (R/PA) and Amy Klobuchar (D/MN) and U.S. Representatives Ron Kind (D/WI), Jackie Walorski (R/IN), Scott Peters (D/CA), and Richard Hudson (R/NC) in support of H.R. 2207/ 692, the “Protect Medical Innovation Act,” permanently repealing the medical device tax.
  • HLC updated its document of coverage solutions to stabilize the individual healthcare insurance marketplace.
  • On March 13, HLC wrote the House Energy and Commerce (E&C) subcommittee on health about ways to lower the cost of prescription drugs and reduce barriers to market competition.
  • On March 12, HLC joined a group letter with the Diabetes Advocacy Alliance (DAA) to the House and Senate Appropriations Committee advocating for increased funding to the Centers for Disease Control and Prevention.
  • On March 12, HLC wrote Representative Ami Bera (D/CA) in support of R. 1398, “To delay the reimposition of the annual fee on health insurance providers until after 2021.”
  • On March 7, HLC submitted comments to the Senate Special Committee on Aging in advance of its hearing on “The Complex Web of Prescription Drug Prices.”
  • On March 6, HLC wrote the E&C Committee in support of its hearing on “Legislation to Lower Consumer Costs and Expand Access.”
  • On March 1, HLC wrote the Senate Health, Education, Labor, and Pensions (HELP) Committee regarding solutions to address America’s rising healthcare costs.
  • On March 1, HLC joined a group letter spearheaded by the DAA to the HELP Committee on how the 116th Congress can address America’s rising healthcare costs.
  • On February 12, HLC wrote the House Ways and Means Committee in advance of its hearing on “The Cost of Rising Prescription Drug Prices.”
  • On January 29, HLC submitted a statement for the record to the Senate Finance Committee and House Committee on Oversight and Reform on lowering drug prices.
  • On January 28, HLC wrote Senator Cory Gardner in support of his sponsoring S. 172, the “Health Insurance Tax Relief Act,” repealing the health insurance tax (HIT).
  • On January 28, HLC wrote the House Education and Labor Committee on preexisting conditions. HLC provided Congress with recommendations to ensure stability in the individual health insurance marketplace.
  • On January 23, HLC issued a press release endorsing bipartisan Senate legislation to extend the HIT delay for two years.