What you should know about the Healthcare.gov Open Enrollment

Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

From November 1, 2020 to December 15, 2020, consumers will be able to enroll in health coverage through the health insurance marketplace, Healthcare.gov. Choosing the right health plan involves thoughtful decision-making, with careful consideration of your needs and your budget. COVID-19 testing and treatment, telehealth, and mental health services have been vital pandemic necessities, and consumers are advised to pay attention to any changes in their current health plans to account for any adjustments in health needs.

It is estimated that annually consumers typically spend 17 minutes when selecting plan options during open enrollment, most simply sticking with their plans from the previous year. If you need assistance navigating the health insurance marketplace, you can consult a healthcare navigator to help in comparing the coverage options that make sense for you. Healthcare navigators provide free, unbiased advice and offer services in a number of languages. To find a navigator in your area, please click here.

Even with the election and looming challenge to the ACA coming before the Supreme Court, California v. Texas, consumers should know that the federal health insurance marketplace, also known as Obamacare, is still available. The Supreme Court will hear oral arguments on November 10, but the ultimate decision can come as late as June 2021. We’ve written more about the implications of California v. Texas here. Despite multiple attempts by opponents to repeal the ACA, over 20 million people have gained coverage through the marketplace in the past decade.

The Centers for Medicare & Medicaid Services (CMS) recently announced that marketplace premiums have dropped by 2 percent nationally. Additionally, as a result of the pandemic, the marketplace has seen greater insurer participation – in turn, offering consumers with more robust options for coverage. Plans offered via Healthcare.gov are required to cover a set of essential health benefits mandated by the ACA, ensuring that you have access to comprehensive care – a provision that is of chief importance during this time. The ACA has afforded consumers with a host of health protections and prohibits insurance plans from discriminating against enrollees based on health status, including pre-existing conditions. To learn more about the marketplace, click here.

The National Consumers League encourages consumers to seek coverage via ACA compliant plans offered on the marketplace. If you miss the deadline to apply for coverage within the open enrollment period, you may be able to qualify for a Special Enrollment Period (SEP). Applying during a SEP is contingent upon meeting certain criteria, such as life events like having a child or losing health coverage. If you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can apply at any time. Most importantly, in order to have coverage that is effective by January 1, 2021, you must sign up by December 15, 2020.

CMS Proposed Rule Ignores Data & Bipartisan Support for the Value of Copay Assistance Programs

By NCL Director of Health Policy Jeanette Contreras

Americans love getting a discount. As consumers, we like to shop to save without compromising the quality of the products we buy. But in healthcare, the stakes are higher at the checkout counter. Patients not only want a discount, they depend on it to afford necessary, sometimes lifesaving, medication to treat their health condition.

Despite what we know about the value and impact of copay assistance programs, a new policy from the Centers for Medicare & Medicaid Services (CMS) could put a barrier between these critical programs and the patients who need them most.

Manufacturer copay assistance programs include discounts, coupon cards, and vouchers which many of our friends, family members, and neighbors use to afford their prescriptions. Studies have shown that without these financial support systems, many patients couldn’t afford their medicines.

The CMS proposal, which has yet to be finalized, would require manufacturers to guarantee that this assistance goes directly to patients—and if manufacturers do not, they would be required to include the value of the copay assistance in Medicaid Best Price and Average Manufacturer Price (AMP) calculations. That would be fine but there’s a  problem.

CMS has a separate policy that was already finalized earlier this year: the Notice of Benefit and Payment Parameters (NBPP) Rule for 2021. In part, the NBPP allows health insurance companies and pharmacy benefit managers (PBMs) to use policies that stop copay assistance from counting towards a patient’s out-of-pocket burden—sometimes called copay accumulator adjustment programs.

NCL criticized HHS for permitting health plans to use these so-called copay accumulator adjustment programs.

“Removing this cost-sharing assistance will force those patients to pay thousands of dollars more in unexpected costs at the pharmacy. These new costs could push some to forego those medications, leading to worsened health outcomes. This could compromise medication adherence and will lead to increased health care costs over time.” – NCL Executive Director Sally Greenberg

Separate studies conducted by the Centers for Disease Control and Prevention (CDC) and IQVIA show that out-of-pocket costs can contribute substantially to reduced adherence or to patients not taking their medication altogether. This is counterproductive because if patients do not take their meds as directed, it means higher costs in other parts of the healthcare system stemming from increased hospitalizations, ER visits, and long-term health issues.

If the data doesn’t convince CMS, voters should. Weeks before the presidential election, we can clearly see widespread support for the value of copay assistance regardless of political affiliation. According to a new National Hemophilia Foundation national survey, more than 80 percent of registered voters believe the government should require copay assistance to be applied to patients’ out-of-pocket costs. Even lawmakers agree that CMS should stop this policy before it launches. A bipartisan group of 36 members of the U.S. House of Representatives sent a letter to CMS urging the agency to not finalize the “contentious line extension section or the Medicaid best price change as currently defined in the notice of proposed rulemaking.”

Clearly, copay assistance is critical to Americans. We hope CMS reevaluates the potentially harmful consequences of this new rule on patients and pulls back this counterproductive proposal.

National Consumers League Expresses Concern Over Amy Coney Barrett Confirmation

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC – The next three weeks will be critical for the American people. Amid a global pandemic, a historic presidential election, and the attempt to fill an equally historic Supreme Court vacancy, there’s a lot at stake for health care. On October 26, the Senate will vote on Judge Amy Coney Barrett’s nomination to succeed the late Justice Ruth Bader Ginsburg on the US Supreme Court. On November 10, merely a week following the presidential election, the Supreme Court of the United States (SCOTUS) hear arguments in the case of California v. Texas, the latest challenge to Patient Protection and Affordable Care Act (ACA), more commonly called Obamacare.

The rush to fill Justice Ginsburg’s seat on the Court on the eve of this election has worried health advocates and consumers alike, as a conservative majority court could potentially overturn the ACA. Conservatives have been hostile to the law, and Coney Barrett, herself an arch-conservative, seems to share that very hostility toward the ACA. This is illustrated by her disapproval of Justice John Roberts Jr.’s support of the ACA in a 2017 essay. In it, Coney Barrett wrote that Justice Roberts had “pushed the Affordable Care Act beyond its plausible meaning to save the statute.”

In 2017, the strife between Democrats and conservatives worsened when the individual mandate provision of the ACA was found unconstitutional. Following that ruling, conservatives have tried to grasp at opportunities to repeal the entire law, including arguing for severability. Severability of the individual mandate provision, as explained by Justice Roberts, would allow the Court to excise the provision with “a scalpel rather than a bulldozer.” Severability would still maintain the ACA as the law of the land and would save access to healthcare for over 20 million Americans. But the plaintiffs, all Republican Attorneys General from across the country, have argued that the individual mandate cannot be severed and if it goes down, the whole law falls.

Although Coney Barrett was reticent during the Senate Judiciary Committee hearings, her record serves as a warning about how she will come down on a host of consumer health issues. These include reproductive decisions granting women agency over their bodies and the freedom to choose how they form families. Based on her prior endorsement of the anti-choice organization Right to Life and her public support of overturning Roe v Wade, there is cause for concern that medical interventions like contraception, abortion, and even in-vitro fertilization (IVF), could all be at risk following Judge Barrett’s appointment to the high court.

Aside from reproductive issues, there are countless health care protections on the chopping block pursuant to the ACA deliberation. Below are a few at risk if the ACA is overturned:

The stakes are high. If the ACA is overturned, COVID-19 could be considered to be a pre-existing condition. The pandemic has laid bare deep structural inequities; stripping away coverage during such dire times would be unconscionable.

There are a few ways the Supreme Court could rule on the case come November 10.

  • If Coney Barrett is not sworn in before the oral argument, the Court could vote on the case with an 8-member court, leading to a potential tie. If tied, the case would be returned to the original trial judge for further analysis – meaning that in the interim, the ACA would remain the law of the land, ensuring protections for millions.
  • The Court may still rule in favor of salvaging the ACA. Many scholars deem the plaintiffs’ arguments to be legally weak. This is where the argument of severability comes in.
  • Finally, if a new justice is appointed to the Court and there is a majority vote to overturn the ACA, it may be overturned. The ACA is an extraordinarily complex and comprehensive law, and this result would wreak havoc across virtually every area of health policy.

Over the next few weeks, the health and civil liberties of millions of Americans will hang in the balance. NCL does not support Judge Amy Coney Barrett’s nomination. Justice Ginsburg was a champion of rights and protections for consumers and women and a strong defender of the ACA. Confirming a justice for the Supreme Court with Coney Barrett’s record before the election has the potential to endanger lives already vulnerable during this pandemic. We simply cannot afford to throw consumers’ health care into such chaos and uncertainly during this COVID-19 pandemic.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Advocating for emergency air transport coverage

This spring, NCL sent a letter to the CEOs of Cigna, Aetna, and UnitedHealth Group, urging them to enter into productive negotiations with air medical service providers to ensure coverage of emergency air medical transportation. The ask came as the COVID-19 pandemic spread across the country, making air medical services even more essential, particularly in rural America.

“We are increasingly concerned about emergency air medical access during this crisis, and believe this life-saving care should be covered by every insurance plan,” said NCL Associate Director of Health Policy Nissa Shaffi.

“We are asking that insurers review the robustness of their coverage policies and immediately enter into network negotiations with air medical providers so that this critical service is covered, and patients are never left with a bill they cannot pay.”

Top of mind: HHS’s reversal of Obama-era transgender nondiscrimination healthcare protections

Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

On June 12, the Trump Administration finalized a rule that proposed to revise, and in effect reverse, Obama-era protections offered in Section 1557 of the Affordable Care Act (ACA). Section 1557, known as the Health Care Rights Law, prevents discrimination of patients based on “race, color, national origin, sex, age, or disability.” In 2016, the Obama Administration expanded the definition of sex to encompass aspects of gender identity as well—extending protections to transgender and gender non-conforming individuals. 

The finalized rule will drastically impact how LGBTQ individuals navigate their health care and health insurance, with regard to nondiscrimination protections. The rule would essentially affect aspects of coverage related to access, cost-sharing, and health plan benefits, specifically, denial of treatment based on someone’s gender transition and/or a provider’s moral or religious beliefs.

The U.S. Department of Health and Human Services (HHS) released a statement following this news expressing that reinstating the original definition of the protections offered would relieve the American people of approximately $2.9 billion in “unnecessary regulatory burdens”. These so-called burdens also include eliminating mandates for regulated entities to provide patients and customers with language accessibility pertaining to health care literature.

Considering the nexus of a global pandemic, civil unrest due to systemic racism, compounded by the epidemic of fatal violence against Black transgender people – the timing of this rule is not only inopportune but exceptionally cruel. The National Consumers League is appalled at the reversal of these protections during a pandemic that is disproportionately impacting vulnerable communities. We urge health insurers and providers to do the right to protect patients by keeping politics out of professional medical judgment when providing services to their patients and customers.

The National Consumers League supports expanded COBRA coverage

By Sally Greenberg, NCL Executive Director

In a perfect world, every person in the United States would have quality health care coverage, irrespective of whether they were employed or whether their employer-offered health insurance. The National Consumers League (NCL) has long advocated for universal access to health insurance for every American.

For political reasons, however, we still have a hybrid, expensive, and patchwork health care system. Thankfully, the Affordable Care Act addresses some of these disparities for millions, but our health care system in the United States still leaves many gaps in who can get coverage. And now, with the COVID-19 pandemic, the gaps in our social safety net have been made very stark indeed. Estimates are that 27 million Americans who have lost their jobs have lost their health insurance as well, according to an analysis from the Kaiser Family Foundation.

An estimate from the Robert Wood Johnson Foundation found between 25 million and 43 million people could lose their employer-sponsored insurance in the coming months if job losses continue.

However, help is on the way.

The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act passed the House of Representatives on May 15, 2020. The bill addresses the COVID-19-induced massive unemployment/loss of health insurance crisis for Americans who receive their health insurance through their employer.

The HEROES Act allows individuals eligible for Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage to maintain their employer-sponsored coverage after a layoff, reduction in hours or furlough without having to pay premiums through January 2021. The bill also would provide two special enrollment opportunities for individuals to obtain health insurance: (a) during the emergency period for Medicare-eligible individuals residing in an emergency area who have not previously enrolled in Medicare and (b) during an eight-week enrollment period for an Affordable Care Act exchange for individuals who are uninsured for whatever reason. The bill would authorize veterans without a disability or health insurance to qualify for special enrollment in the Veterans Affairs (VA) healthcare system for a 12-month period. Finally, the bill would expand the Medicaid expansion pathway provided for in Families First, which covered 100 percent of testing costs. HEROES would expand this pathway to include full federal coverage for COVID-19 treatment and vaccines without cost-sharing for certain Medicaid enrollees.

There are issues, of course, with handing over billions of dollars to the health care industry through expanded COBRA that they might not have received otherwise. Among them, they pay excessive salaries to their CEOs that should trouble all of us who pay insurance premiums.

There is also the possibility that increasing access to private insurance via COBRA subsidies could stunt nationwide efforts to expand Medicaid for more vulnerable populations, to some degree.

But this is a case where we cannot let the pursuit of perfection be the enemy of the good. For nearly 40 million Americans struggling with loss of employment, passage of the HEROES Act will mean that they will not have to worry that neither they, nor their families, will lose health insurance.

We agree with Actors’ Equity, which issued this statement before the HEROES Act was adopted, “it is time for Congress to consider a 100% COBRA subsidy to ensure that no one loses their health care in the middle of a pandemic.” Similarly, our friends at Families USA have echoed the call for fully subsidizing COBRA coverage for displaced workers, among other robust consumer assistance measures. To read more, click here.  

Fully or heavily subsidizing COBRA coverage will have multiple benefits – particularly for consumers with chronic illnesses who have already satisfied their annual deductible- who would either be faced with potentially starting a new deductible from scratch, or with an entirely new provider altogether. By subsidizing COBRA coverage, families will be able to seek medical care, access vaccines and testing for COVID, and will have the full array of health care protections. It is a measure that will be good for the entire nation and will lessen the already frightening and painful loss of employment.

As a result, NCL strongly supports the HEROES Act provisions to subsidize COBRA benefits to the many millions who have lost employment. The House of Representatives has done its part. Now we need the Senate to approve the HEROES Act and move it to the President’s desk for signature. The nation will be far healthier if everyone can have access to health care in the age of this catastrophic COVID-19 pandemic.

NCL expresses concern about Trump Administration’s NBPP rule for 2021

May 26, 2020

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832 

Washington, DC—The National Consumers League (NCL), the nation’s pioneering consumer advocacy organization, expresses concern about the Trump Administration’s Notice of Benefit and Payment Parameters Rule for 2021.

The following statement is attributable to NCL’s Executive Director Sally Greenberg:

“As the COVID-19 pandemic continues to take a toll across the country, consumers should not be subjected to additional obstacles when trying to access the care they need. We are therefore deeply troubled by the Department of Health and Human Services (HHS) decision to permit health plans to use accumulator adjustment programs in its Notice of Benefit and Payment Parameters Rule for 2021.

This is a step in the wrong direction at a time when consumers are struggling to make ends meet. Under these programs, health insurers are not required to count manufacturer cost-sharing assistance toward patients’ annual deductibles, even when no medically appropriate generic equivalent is available. Many patients typically rely on very specific treatments that have no generic or other alternative, resulting in already high out-of-pocket spending. Removing this cost-sharing assistance will force those patients to pay thousands of dollars more in unexpected costs at the pharmacy. These new costs could push some to forego those medications, leading to worsened health outcomes. This could compromise medication adherence and will lead to increased health care costs over time.

Given the significant financial pressure this will place on patients and the negative impact it could have for our health care system as a whole, we ask that HHS reconsider the reversal of its original protections against these programs. Any subsequent course of action should seek to take the burden off of consumers. Employers and insurers must recognize that this is not the time to create barriers to care and refrain from implementing accumulator adjustment programs in 2021.”

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneering consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

 

NCL expresses concern about Trump Administration’s NBPP rule for 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832
Washington, DC—The National Consumers League (NCL), the nation’s pioneering consumer advocacy organization, expresses concern about the Trump Administration’s Notice of Benefit and Payment Parameters Rule for 2021.

Top of mind: Full coverage should mean full coverage

Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

The National Consumers League is troubled by the recent report by Public Citizen, “Insurers’ Offers of Free Care for Coronavirus Are Often Confusing and Limited.” In these traumatic and confusing times, it’s critical that consumers can rely on their healthcare insurers to follow the spirit of the law as well as the letter of the law. This includes being crystal clear about what is covered, under what conditions, and for how long. 

Public Citizen’s research into 25 of the largest health insurers turned up a range of concerning practices. Most fee waivers will expire by early summer, well before the crisis will subside. Few appear to cover costs of out-of-network care, a hardship when the urgency of the illness and overwhelmed facilities may make it untenable to get in-network care. The 60 percent of people in private insurance plans who are covered by their employers’ self-insured plans may not even be covered if the employer does not opt-in. And of long concern to NCL, even free tests may come with associated services the patient may not be aware of, and that lead to surprise billing not prohibited by the law.

We urge insurers to act in good faith. Use the savings you are accruing from lower elective care costs to fully cover the costs associated with this pandemic. Remove arbitrary restrictions. Be clear and fully transparent about what you are offering. Hold the course for the duration. The consumer community is here to help make it happen.