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Legislative and Regulatory Updates Related to the Health Care Industry, August 3, 2020
CMS Releases Early 2020 Health Insurance Exchange Effectuated Enrollment Snapshot – CMS released the Early 2020 Effectuated Enrollment Report for the Federally-facilitated Health Insurance Exchange, finding that 10.7 million ACA customers paid their premiums as of March 15, a slight increase from the 10.6 million who paid through February 2019. “The report confirmed that for the third year in a row, enrollment has remained steady and the number of consumers who paid for coverage in February 2020 increased compared to February 2019,” the agency stated in a press release. CMS also reported that the average total monthly premium for enrollees in February of this year was $576.16, a 3% decline compared with February 2019’s average premium of $594.17. A majority of the exchange population (86%) received an advance premium tax credit, a decline of about 1 percentage point from the same period in 2019.
What the overall impact of the COVID-19 pandemic will be on exchanges and the individual market as a whole remains to be seen. At the onset of the pandemic in March, the 12 state-run exchanges plus the District of Columbia reopened enrollment. This prompted nearly 263,000 people to sign up for coverage. Although CMS did not reopen enrollment for HealthCare.gov, a House bill in response to the pandemic would establish a special enrollment period for the health insurance exchanges if passed. Congress and the administration are currently working on negotiating a new COVID legislative package.
Study Finds Few High-Deductible Health Plan Enrollees are Utilizing HSAs– According to a new study published in JAMA Network Open, few adults enrolled in high-deductible health plans are using health savings accounts to put money away to cover healthcare costs. The researchers surveyed 1,637 people enrolled in an HDHP and found that about two-thirds were enrolled in a plan that includes an HSA. More than half (55%) had not contributed to the account in the past year. According to the study, HDHP members without an HSA were more likely to select their plan through an exchange rather than gain coverage through their employer, with 70% of people without an HSA seeking coverage on an exchange. The survey found that people who reported a high degree of insurance literacy were more likely to have made contributions in the past year to their HSA, with 47.3% making a contribution. One in five people who contributed to their HSA also saved elsewhere for their health care costs, and an additional 20% said they saved for health care solely in a non-HSA account. The share of people with private coverage enrolled in high-deductible plans rose from 25% in 2010 to 40% in 2016, according to the researchers.
Employers Give Insurers Average Grade on Driving Value - A new survey finds that employers, on average, gave their insurer a 2.57 grade point average, or a C-plus, on driving greater value for employees. A total of 174 employers nationwide participated in the survey, representing an estimated 4 million insured lives. Half of the employer respondents represented midsize or small employers with up to 20,000 covered lives each. The other half of respondents came from large employers including ten respondents from very large employers with more than 100,000 covered lives. Respondents cited their experience with health plans including Aetna, Cigna, UnitedHealthcare, as well as a range of BlueCross and BlueShield (BCBS) plans. According to the survey, while employers were generally favorable about their health plan's performance, they see significant opportunities for improvement in the movement for value in health care. Just over half of the employer respondents agree that their health plan is on their side in reducing unnecessary health care costs.
HHS Issues Report on Surprise Billing, Calls for Legislative Action – On July 29th, HHS released the Secretary’s Report on Addressing Surprise Billing. The report urges Congress to enact legislation to protect patients from surprise medical bills. Lawmakers have been in a stalemate for more than a year over legislation to combat surprise billing. An issue that has prevented legislation from moving forward has been how to resolve payment disputes for out-of-network charges. The report outlines three major pieces of legislation that offer varying ways to address out-of-network charges but declines to offer an endorsement of any of the bills.
A compromise bill between the House Energy and Commerce Committee and the Senate HELP Committee would set a benchmark rate for out-of-network charges, and any claims over $750 would go to a “baseball-style” arbitration process. A separate bill from the House Education and Labor Committee offers a similar approach. A House Ways and Means Committee bill calls for voluntary negotiations between payers and providers over a 30-day period, and, if no agreement is reached, the parties would proceed into mediation. In general, providers and hospital groups have typically favored arbitration over a benchmark rate, while payers have favored a benchmark rate approach. Finding a way to resolve the payment dispute between the different pieces of legislation remains elusive as Congress debates the next COVID-19 legislative package, with reports that efforts to bridge differences between the competing plans have not been resolved at this time.
Report Finds Virtual Behavioral Health Could Significantly Expand Access – According to a new report released by Accenture, the use of virtual services during the COVID-19 pandemic to provide behavioral health services could help open up access to behavioral health treatment for millions of patients post-pandemic. Current data indicate nearly 58 million adults and 8 million youth between the ages of six and 17 in the U.S. have mental health and/or substance use disorders, yet only 43% of affected adults are receiving treatment for them. Accenture surveyed 3,400 people in the U.S. diagnosed with or having symptoms related to specific behavioral health conditions such as anxiety, depression, post-traumatic stress syndrome, attention deficit disorder or reported themselves as having addiction or substance abuse issues. Four in five respondents (81%) said they would either definitely or probably engage in a virtual channel to manage their behavioral health condition.
"The behavioral health crisis in the U.S. isn’t new, but the pandemic is clearly exacerbating it,” said Rich Birhanzel, a senior managing director at Accenture who leads the company’s health practice globally. “The rapid expansion of virtual care models during lockdown in the current pandemic created new expectations for effective and reliable healthcare at a distance. While our research found that only 38% of respondents hadn’t been widely using a virtual channel for such treatment in the prior three years, they’re now overwhelmingly willing to do so," Birhanzel said.
Party Committee Votes to Not Include “Medicare for All” in Democratic Party Platform – Democrats rejected efforts to amend the party’s platform to show support for Medicare for All single-payer coverage, as they moved the document closer to adoption by delegates at next month’s Democratic National Convention. The document, approved Monday by the party’s platform committee, aligns closely with presumptive nominee Joe Biden’s campaign proposals, which include a public option and lowering the eligibility age for Medicare, but not support for Medicare for All. The next step is for the platform to be voted on by nearly 4,000 Democratic delegates, which they will do by mail ahead of the convention where Mr. Biden is set to be formally named the party’s nominee. The party platform is largely symbolic, as Democratic candidates do not have to endorse its contents, but it is an official marker of the party’s priorities and policy goals.
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