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NOV02

Washington Healthcare Round Up: Junk Insurance and Medicare Drug Pricing

Although legislators have entered campaign mode in full swing ahead of November 6th’s midterm elections, this week has still been an active one in federal health care policy. Check out some highlights below.

Short-Term, Limited-Duration Insurance

AIDS United is one of seven health organizations taking the Trump administration to court over the expansion of short-term, limited-duration insurance (STLDI) plans, which health care advocates have warned are little more than “junk insurance” that do not meet the minimum requirements of the Affordable Care Act’s insurance regulations. Most concerning for people living with and vulnerable to HIV, these plans grant insurers the ability to discriminate based on health status, meaning that folks with a variety of pre-existing conditions can be charged more or denied coverage. In a study by the nonpartisan Kaiser Family Foundation, a hypothetical person living with HIV was denied coverage in all 38 instances under different versions of these STLDI plans.

In the original ACA legislation, such insurance could only be sold for three-month periods, intended to be a stopgap rather than a permanent insurance solution for folks experiencing some sort of transition or hardship. However, in a rule issued in August, Health and Human Services officials announced that the plans could now be sold in year-long increments and could be renewed for up to three years. Many patient advocacy groups, including AIDS United, are concerned about the potential effects these changes could have on the health care landscape: if people without pre-existing conditions or with generally low health care costs are drawn to these plans, others will be left in the ACA marketplace with rising premiums and no other insurance options.

AIDS United’s court case is an attempt to hold the administration responsible for reducing access to quality care that is still affordable to consumers. Recently, a federal judge in the D.C. circuit refused to issue an injunction that would have stopped these plans from being sold when open enrollment began on November 1st. Instead, and unfortunately to the detriment of consumers, he will wait to see how marketplaces are affected by the new rule, though it has been shown time and again that this “junk insurance” will draw people with lower health costs out of the ACA marketplace. Although the judge ruled against stopping the plans before they took effect, the case is still on, and AIDS United will continue to work with our allies to defend health care.

Medicare Drug Pricing

Last week, the Trump administration announced what appeared to many health advocates as a last-ditch attempt to raise the GOP’s health care profile in the few days ahead of midterm elections on November 6th. President Trump and Health and Human Services Secretary Alex Azar revealed a proposal that would link some of Medicare’s drug pricing negotiation and payment to that of an international drug index that other similarly developed countries use as a price control on manufacturers.

In his usual “America First” style, Trump slammed a multitude of countries as “foreign freeloaders” for not letting drug manufacturers price gouge as they are allowed to in the United States. Interestingly, the proposed rule would be piloted by the Center for Medicare & Medicaid Innovation, an agency created under the Affordable Care Act to reduce the programs’ spending.

The rule would only impact Medicare Part B, the section of the program that pays for drugs administered in a medical facility (e.g. medicines given through an IV drip), but is still one of the most aggressive drug-pricing control plans to be proposed, and certainly by this conservative administration. It’s no secret that drug manufacturers have significant influence on Capitol Hill, so it is unclear how this proposed rule will proceed through the federal rule-making process or how it will be received by pharma-backed legislators. PhRMA, the trade organization of many major drug companies, expressed their “serious concerns” before the announcements and is expected to oppose the rule harshly before possible finalization and implementation.

Check back with AIDS United’s Policy Update regularly for all the latest on federal regulations and legislation affecting HIV/AIDS care, treatment, and prevention in the United States. Before the next issue of the Policy Update is released, however, there’s a very important advocacy action to be taken to protect the rights and care of people living with and affected by HIV: voting. Electing legislators who are committed to protecting the Affordable Care Act and to expanding access to care is the most basic way to ensure that all receive the affordable and quality health care they deserve. Explore AIDS United's Elections Center to get prepared and then get to the polls on Tuesday, November 6th.




Posted By: AIDS United, Policy Department - Friday, November 02, 2018



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