News : Less freedom of association … health plans?

Friday, February 23, 2024

Less freedom of association … health plans?

Feb 23, 2024

Driving The Day

Rep. Bobby Scott speaks with his hand raised behind a microphone and a name plate.

Reps. Bobby Scott (above) and Mark DeSaulnier wrote to the Biden administration in support of its proposal to reverse a Trump-era rule favoring association health plans. | Rod Lamkey/AP

BIDEN PLAN REVERSAL — The Biden administration’s proposal to rescind a Trump-era rule making it easier for small businesses to team up to buy health insurance is drawing mixed reviews.

By joining a large association health plan, small businesses can avoid some regulations that apply only to smaller plans. The Trump-era rule has been in limbo amid a court battle.

Biden’s proposal drew kudos from Democrats in Congress and consumer and doctors groups with the rule’s comment deadline passing this week.

The American Academy of Family Physicians and the Medicare Rights Center wrote that the Trump administration’s regulations would undermine coverage requirements under the ACA and hurt patients’ pocketbooks.

Reps. Bobby Scott (D-Va.), ranking member of the House Education and the Workforce Committee, and Mark DeSaulnier (D-Calif.), ranking member of its health subcommittee, called on the Biden administration to “prioritize protecting consumers from these harmful arrangements in any future rulemaking.”

“The [Trump rule] would have been harmful to millions of consumers, including people enrolled in AHPs as well as those left behind in the traditional insurance market,” Scott and DeSaulnier wrote.

The proposal was criticized by Congressional Republicans and groups representing some employers, providers and insurers.

The National Federation of Independent Business wrote that the Biden administration is showing “hostility” toward small businesses’ attempts to provide workers with “affordable, flexible and predictable health benefits.” The Council for Affordable Health Care Coverage and the Health Benefits Institute said employers are increasingly dropping coverage, and eliminating the option of such plans will make the issue worse.

“The Biden administration continues to double down on policies that will limit choice and increase health care costs,” said Rep. Virginia Foxx (R-N.C.), chair of the Education and the Workforce Committee, pushing legislation to expand the Trump rule that advanced through the committee along party lines in June.

Thirteen House Republicans led by Rep. Chuck Edwards (R-N.C.) and Kevin Hern (R-Okla.) said the plans can help families deal with higher cost of living and have been “unfairly maligned.”

The history: A federal court in 2019 struck down portions of the rule, which loosened requirements for the types of employer groups and associations that could sponsor a single-group health plan. The Trump administration appealed that ruling, but the case stalled as the Biden administration reviewed the 2018 regulations.

In December, the Labor Department moved to rescind the rule and reexamine the criteria employer groups must meet to sponsor an association health plan.

WELCOME TO FRIDAY PULSE. It’s a great day for panda fans: China is reportedly in discussions to send new pandas to Washington. Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.

In Congress

U.S. House Minority Leader Hakeem Jeffries (D-NY), U.S. Senate Minority Leader Mitch McConnell (R-KY), U.S. Senate Majority Leader Chuck Schumer (D-NY) and U.S. Speaker of the House Mike Johnson (R-LA) listen to remarks in the Capitol Building.

Time is running out for congressional leaders (from left) Rep. Hakeem Jeffries, Sens. Mitch McConnell and Chuck Schumer and Rep. Mike Johnson, who are facing March 1 and March 8 funding deadlines. | Anna Moneymaker/Getty Images

FUNDING LATEST — Appropriators are staring down a massive lift to meet rapidly approaching funding deadlines, POLITICO’s Caitlin Emma and Jennifer Scholtes report, even if FDA and VA funding bills are ready by this weekend.

Congress has until March 1 to fund those agencies and March 8 to fund HHS, meaning time is waning for leaders to decide whether they’ll need to resort to another temporary funding patch. A source familiar with the talks said congressional leaders hope to make an announcement Sunday night.

Lawmakers could employ a hybrid funding situation in which less complicated bills are ready for the floor, but leaders would have to buy more time for more controversial measures like the bill funding HHS.

DEMS PUSH INSURERS ON BIRTH CONTROL — More than 150 House and Senate Democrats are pushing insurers to do more to cover contraception.

The group of lawmakers led by Reps. Lois Frankel (D-Fla.) — chair of the Democratic Women’s Caucus — and Judy Chu (D-Calif.) and Sens. Elizabeth Warren (D-Mass.) and Catherine Cortez Masto (D-Nev.) on Thursday called on insurer lobby AHIP and UnitedHealth Group to meet coverage requirements under the Affordable Care Act.

They want the plans to cover all FDA-approved contraceptives that don’t have a generic alternative without cost-sharing after what they said has been “years of systemic noncompliance” that makes patients pay out of pocket or deal with “red tape.”

The backstory: The ACA requires most private health plans to cover contraception at no cost to consumers, but regulators’ and industry’s interpretation of the mandate has largely favored generic products over pricier brand names — even when women seek a birth control method with no low-cost alternatives because the product is new to the market.

In January, the Biden administration released additional guidance explaining the ACA’s coverage requirement applies to all FDA-approved contraceptive methods that don’t have generic equivalents. Plans may opt to cover just one generic per birth control method category if those equivalents exist, provided they maintain an exceptions process if patients are prescribed a specific brand. The lawmakers called on the insurers to adopt that standard.

Insurers respond: AHIP general counsel Julie Miller said in a statement to Pulse that the group looks forward to sharing more on how it’s implementing the guidance and said, “robust and affordable coverage of contraception as required under law remains a priority.”

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IN THE STATES

GOP GOVS ON IVF RULING — Several top Republicans said they support in-vitro fertilization days after Alabama’s high court ruled that frozen embryos can be deemed children under state law.

At the POLITICO Governors Summit in Washington on Thursday, Govs. Brian Kemp of Georgia, Bill Lee of Tennessee, Kevin Stitt of Oklahoma and Chris Sununu of New Hampshire weighed in on the issue. It complicates the GOP’s standing with millions who might oppose abortion but back in-vitro fertilization and other types of fertility care.

Kemp: The Georgia governor said he hasn’t been able to look over the ruling, but he’s generally comfortable with IVF. “You have a lot of people out there in this country that they wouldn’t have children if it weren’t for that,” he said.

Lee: The Tennessee governor said, “Generally, I am supportive of IVF,” adding that he doesn’t yet know “the details of that case and ruling.”

Stitt: The Oklahoma governor said he didn’t think destroying embryos is a crime but defended each state’s ability to determine their own policies on reproductive rights and access to abortion.

Sununu: The New Hampshire governor, a self-described “pro-choice” Republican, called the ruling “scary.” “You want to make sure those services are accessible,” he said.

HEALTH TECH

STANDARDS FOR HUMAN SERVICES — HHS is exploring ways to set standards for how human services organizations, like those that work with children or older Americans, share data, a top HHS official said Thursday, Chelsea reports.

Micky Tripathi, HHS’ National Coordinator for Health IT, said during a Health Affairs webinar Thursday there are “more announcements to come” on the interoperability efforts.

“There are certainly areas that we haven’t gotten to with respect to interoperability, and human services is one of them,” Tripathi said. “We’ve done a lot of work on the health care side, and we’re now starting to turn to human services.”

That includes getting human services organizations to adopt open industry standards and other standards that have already been adopted among health care organizations, he added.

He warned, however, that it might take a while since most groups aren’t covered under HIPAA.

Tripathi pointed to California as a successful model to follow. The state released a Data Sharing Framework in 2022 for government agencies and health care companies to share health information. Tripathi praised the framework for setting up a foundation for data-sharing that could be extended to human services organizations.

Names in the News

Joseph Papa is now president and CEO of Emergent BioSolutions. He was previously CEO and chair at Bausch and Lomb Corporation.

Shannon Kellman is now senior adviser in the U.S. Liaison Office of UNAIDS. She most recently was senior policy director at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria.

WHAT WE'RE READING

POLITICO reports on how more Alabama clinics are pausing IVF treatments after a court ruling.

Modern Healthcare writes on a cyberattack at Change Healthcare that has reportedly impacted pharmacies.

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