Washington Wire: July 2022

One key provision of the Affordable Care Act (ACA) requires most health insurance plans to cover – without cost-sharing – services that help screen for and prevent disease. Annual primary care visits, immunizations, cancer screenings, and improved access to birth control are just a few of the categories of preventive services that are available without cost-sharing to millions of Americans covered under ACA-compliant private health plans.

A pending lawsuit now threatens to limit access to those preventive services. Plaintiffs in Kelley v. Becerra say they want to buy health plans that do not cover contraceptive services or HIV prevention products (required under the preventive service benefit), and therefore ask the court to overturn the ACA preventive services mandate. They argue that the ACA preventive services requirement violates their religious freedom and wrongly delegates the authority to define the scope of covered preventive services to various federal agencies, advisory committees, and task forces, some of which are headed by non-Senate-confirmed appointees.

If the court rules in favor of the challengers, insurance companies could once again require patients to satisfy deductibles and copays before they can access common preventive care – re-creating financial barriers that in the past barred many Americans from obtaining such care. Judge Reed O’Connor, a federal district court judge in the Northern District of Texas, heard oral arguments in the case on July 26. HFA joined with 22 other patient organizations in a statement defending patients’ right to access these critical services.

Quick Hits:

• • HFA was thrilled to host 14 participants at our Young Adult Advocacy Summit (YAAS) in Washington, D.C. in July. With participants from as far away as Alaska and as close as Virginia, the 2022 Summit was the first time that this event has taken place in-person since 2019. Participants took part in listening sessions and developed advocacy, coalition building, professional development, and leadership skills through interactive training. The YAAS advocates conducted virtual legislative meetings with Congressional offices regarding the federal copay accumulator adjuster bill (H.R. 5801); this allowed participants to apply their learned knowledge and share their experience in the bleeding disorders community.

• • The U.S. Senate is, at last, moving forward with a budget reconciliation bill that includes some major health-related provisions. Details remain very much in flux, but as of July 28, the bill would extend enhanced premium subsidies for ACA Marketplace plans[1] (an HFA policy priority) for three years. The bill also would subject a defined number of brand name drugs to Medicare drug price negotiation, beginning in 2023, and would limit seniors’ annual out-of-pocket spending on Part D drugs. The bill is currently under review by the Senate parliamentarian; she will determine whether the legislation meets the criteria for a reconciliation bill (allowing it to pass the Senate by a simple majority, rather than having to clear the filibuster-proof 60 vote threshold).

• • On July 25, HHS proposed rules broadening nondiscrimination protections for patients in certain federally funded health programs pursuant to Section 1557 of the ACA. Among other things, the proposed rule: clarifies that the ACA’s nondiscrimination requirements extend to health insurance issuers that receive federal financial assistance; clarifies that (impermissible) discrimination on the basis of sex includes discrimination on the basis of sexual orientation, gender identity, pregnancy, and pregnancy termination; and affirms that Section 1557 prohibits the use of discriminatory health benefits designs and marketing practices. The rule will be open for public comment for 60 days following its publication in the Federal Register.

• • A tri-agency group (the U.S. Departments of Health and Human Services, Treasury, and Labor) issued new guidance to health insurers reminding them that federal law requires them to cover all FDA-approved methods of birth control (including hormonal therapies) with no patient copays. If you believe your health plan is not complying with this law, please reach out to advocacy@hemophiliafed.org.

• • On July 15, HHS once again extended the declaration of a public health emergency in response to the ongoing COVID-19 pandemic. The renewal means that waivers allowing for expanded telehealth services, enhanced federal funding for Medicaid, and a pause on Medicaid disenrollments will continue at least until October 13, 2022.

• • On July 27, the U.S. House of Representatives by a 416-12 vote approved a bill extending telehealth flexibilities through the end of 2024. If it passes the Senate and is signed by the President, the bill will allow Medicare and certain health centers to continue covering telehealth visits from patients’ homes, as well as some audio-only telehealth services.

• • New price transparency rules went into effect for health insurers and employer-sponsored health plans on July 1. Under the rules, most health payers must begin posting pricing information for covered items and services. A related rule, requiring health payers to disclose what they pay for prescription drugs, has been postponed while the government reconsiders whether the requirement remains appropriate.

• • The U.S. Centers for Medicare and Medicaid Services sent a letter to Tennessee advising the state that its Medicaid program should not proceed with Trump Administration-approved plans to limit drugs available to enrollees; should submit a new financing model to replace its proposed block grant structure; and may not take steps to cut benefits or coverage without submission of an amendment subject to public comment and approval. Tennessee subsequently posted an amendment to its Medicaid waiver application removing the block grant cap and the closed drug formulary.

[1] The 2021 American Rescue Plan Act increased the size of federal subsidies for Marketplace plans and made the subsidies available to more people, easing barriers to coverage for millions of Americans. But the ARPA’s enhancements are temporary and expire at the end of 2022. Health analysts have warned of a looming rate shock if Congress doesn’t act to extend the enhanced premium subsidies.