AHIP, ACAP Call for Reversals on Prior Administration’s Policies
AHIP and ACAP pushed for a close review of--and potentially permanent changes to--rules such as the rebate rule, Medicaid work requirements, and the Healthy Adult Opportunity waivers.
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- Major payer organizations, specifically America’s Health Insurance Plans (AHIP) and the Association for Community Health Plans (ACAP), are calling for a reversal on key Trump healthcare policies.
The Biden administration has paused all of the previous administration’s healthcare policies in order to review them, particularly those related to Medicaid and the Affordable Care Act as well as other areas of healthcare policy. While payer organizations applauded this decision, some hoped that the freeze would be permanent on certain regulations.
ACAP enumerated a few policies that the organization want to see reversed and AHIP emphasized its desire to see the rebate rule removed.
After an executive order required federal health departments and agencies to review all policies related to Medicaid and the Affordable Care Act, Margaret Murray, chief executive officer of ACAP, came out with a statement elucidating her payer organization’s regulatory priorities.
“We commend President Biden for creating a special enrollment period for the federal Marketplaces,” Murray began. “The pandemic led to financial difficulties and changes in health coverage for millions, which did not stop at the end of open enrollment. Consumers deserve time to thoughtfully consider and select the plan that best meets their needs—we thank President Biden for taking a long-overdue action.”
Policies that support short-term limited-duration health plans—also known as “junk plans”—should be eliminated, the statement argued.
“In two years, junk insurance plans have created havoc for consumers, promising access to affordable, comprehensive coverage only to leave them holding a stack of unpaid bills when they need to access said coverage,” Murray asserted.
“When allowed to compete directly with ACA-compliant plans, junk insurance plans erode consumer protections and send premiums spiraling higher. We urge the Administration to reverse this rule.”
These plans were a key part of the Trump administration’s approach to healthcare coverage. The previous administration extended the duration for this type of health plan so that consumers could stay on a short-term limited duration health plan for up to three years. The policy stirred concerns in the Senate and industry skepticism but remained in place.
Additionally, ACAP spoke out against Medicaid work requirements.
“ACAP has long maintained that Medicaid helps people who work stay on the job – a job shouldn’t be a requirement for Medicaid,” Murray reiterated. “Work requirements add another layer of red tape and administrative burden to an enrollment process that’s complex enough as is.”
As of January 26, 2021, eight work requirement section 1115 demonstration waivers have received CMS approval, according to a Kaiser Family Foundation tracker. Seven waivers are pending and four waivers in four states have been set aside by the courts.
These waivers have been the source of much controversy, most notably when an appeals court invalidated Medicaid work requirements in the state of Arkansas.
Lastly, ACAP requested that the administration review the Healthy Adult Opportunity waiver.
“ACAP supports Medicaid modernization, so long as it follows certain key principles—that it covers all Medicaid enrollees equitably and provide state budget writers with certainty,” Murray explained. “Some Medicaid innovations are faithful to these principles. The Healthy Adult Opportunity initiative is not.”
AHIP responded to the White House’s move to delay the rebate rule until 2023.
Matt Eyles, president and chief executive officer of AHIP, emphasized that the rebate rule would constitute a bailout for pharmaceutical manufacturers and that it would increase prescription drug pricing. He stated that the rebate rule would raise premiums and cost taxpayers billions of dollars.
Previously, AHIP estimated that the premiums could rise as much as 25 percent as a result of this rule. However, proponents say that the rule will deliver point-of-sale discounts to help consumers afford their medications.
“While we continue to urge full withdrawal of the prior Administration’s rule, this delay will allow Medicare Part D plans in 2022 to provide the benefits and premiums seniors have come to expect,” Eyles said.
Some experts expect that the Biden administration will review and potentially roll back many of the policies that these payers have outlined.
