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ACA ENHANCEMENTS BOOST HEALTH PLAN ENROLLMENT

The U.S. Department of Health and Human Services announced on May 11 that more than 1 million Americans have signed up for coverage on www.HealthCare.gov during the Special Enrollment Period (SEP) that opened February 15. The SEP – still ongoing, in most states – creates broad new opportunities for consumers to enroll in ACA health insurance. These enrollment opportunities, together with the substantial new subsidies provided by the American Rescue Plan Act (ARPA), make it possible for many consumers to get coverage, upgrade to a more robust health plan and/or lower their costs for coverage. And many have done just that! HHS reports that about 1.9 million people have returned to the Marketplaces since the ARPA was signed to claim the larger subsidies, with 469,000 signing up for new coverage in April alone.

To learn more about enrollment opportunities during the SEP and whether the ARPA can save you money on your health insurance, check out this recorded webinar and this information sheet (both jointly produced by HFA and NHF). 

Quick Hits:

  • On May 13, Missouri Governor Parsons formally withdrew his state’s Medicaid expansion application. This action followed the Missouri legislature’s refusal to fund the state’s Medicaid expansion, which – per the Missouri Constitution – is supposed to go into effect July 1, 2021. Three plaintiffs, people who would be eligible for Medicaid coverage under the voter-passed Medicaid expansion, filed a lawsuit against the state Department of Social Services, seeking a ruling that would allow them to enroll and receive benefits.
  • HHS’s Office of Civil Rights announced on May 10 that it will restore an expansive reading of who is entitled to protection under the ACA’s nondiscrimination provisions. OCR will again accept and investigate complaints of sex discrimination on the basis of sexual orientation and gender identity. (The previous Administration had adopted a narrower reading of the ACA’s statutory prohibition against sex discrimination, but courts had blocked that narrower rule from going into effect.)
  • The Centers for Medicare and Medicaid Services published the second half of its notice spelling out “benefit and payment parameters” (NBPP) for 2022 ACA plans. Among other things, the NBPP revises next year’s ceiling on patient cost-sharing, shaving off $400 from CMS’s original proposal. (The final maximum annual limitation on cost sharing for 2022 is still high – $8,700 for self-only coverage and $17,400 for family coverage – but it represents a smaller increase than CMS had initially proposed.)
  • This latest iteration of the NBPP – like the first installment of the rule, and despite requests from patient advocates – does not address health plans’ use of copay accumulator adjusters. HFA continues to advocate for protections for individuals who rely on copay assistance. HFA joined with other All Copays Count Coalition members in a May 17 letter to HHS, urging the agency to revisit accumulators in the next NBPP – or before. At the state level, HFA welcomed the enactment of accumulator adjuster legislation in Tennessee (May 13), and we are continuing to support bills that are moving forward in Connecticut, Oregon, New York, Louisiana, and elsewhere.
  • Accumulator adjusters are also at issue in a challenge filed by PhRMA against CMS’s 2020 rule addressing value-based purchasing arrangements used by state Medicaid programs. PhRMA argues that the CMS rule undermines copay assistance programs, wrongly counting financial assistance (intended to help patients) as part of the price that the drug maker offers to health insurers. Factoring in these sums lowers the “best price” calculation and, in turn, increases the rebates that drug makers owe to state Medicaid programs.
  • In 2020, six drug makers announced that they would discontinue offering discounted pricing to hospitals and clinics that dispense 340B drugs through contract pharmacies. By letters dated May 17, HHS advised the drug makers that their actions violate the law and ordered them to reinstate the discounts. Observers expect that the fight over 340B discounts will continue, possibly moving into the courts.
  • On May 25, the Senate confirmed Chiquita Brooks-LaSure to serve as Administrator of CMS.

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