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.  Notably, 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 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 coverage choice 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:

  • On May 14, HLC issued a press release endorsing the “Health Care Protection Act,” which would help Americans who have lost their jobs during the COVID-19 pandemic maintain their private health insurance coverage though COBRA.
  • On May 12, HLC sent a letter to Representative Rodney Davis (R/IL) in support of the “Health Care Protection Act.”
  • On April 28, HLC in a press release urged Congress to take steps to maintain private health insurance coverage for the millions of Americans losing jobs and health insurance due to the economic fallout from the COVID-19 pandemic.
  • On April 17, HLC shared its COVID-19 key legislative priorities list with Senate and House leadership for consideration in future COVID-19 legislative packages.
  • On March 23, HLC joined a coalition letter to Senate and House leadership on providing COBRA subsidies during the COVID-19 pandemic.
  • On March 12, HLC released a blog post on the underutilization of preventative interventions to reduce healthcare costs.
  • 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.”