U.S. Capitol Building. (Photo: MikeScarcella/ALM)
U.S. health insurers' biggest trade group has told Congress thathealth insurers want help with continuing to protect the ability ofAmericans with pre-existing health conditions to get access toaffordable health coverage.
|America's Health Insurance Plans (AHIP)delivered that message in written statements submitted to the HouseEnergy and Commerce health subcommittee and to the House Educationand Labor Committee.
|“Americans with pre-existing conditions should be protected,”AHIP said in the statements. “The position of health insuranceproviders is clear: Every American deserves affordable,comprehensive coverage — regardless of their income, health status,or preexisting conditions. No one should be denied or priced out ofaffordable coverage because of their health status.
|Related: States attacking ACA's pre-existing conditionprotections have the most to lose
|AHIP told members of Congress that it believes Congress can helppreserve insurers' ability to offer affordable coverage on aguaranteed-issue basis by:
- Maintaining a healthy insurance public exchange system, to helpconsumers shop for coverage.
- Maintaining premium subsidy programs, to ensure that low-incomeand middle-income people can pay for coverage, and keep healthypeople in the market.
- Maintain and strengthen the current open enrollment period andspecial enrollment period systems, to discourage people fromwaiting until they get sick to pay for coverage.
AHIP said it would also like to see Congress add more programs,incentives and penalties to encourage people to maintain“continuous coverage,” rather than paying for coverage only whenthey expect to need expensive medical care.
|AHIP said that the Affordable Care Act “individual mandate,” orprovision requiring many people to have what the governmentclassifies as solid major medical coverage, is one type ofcontinuous coverage policy approach.
|“Other policies for promoting continuous coverage beforeindividuals become ill or injured include premium surcharges (orlimitations on the availability of premium tax credits), limitedplan choices, or waiting periods,” AHIP said. “Some policy analystshave also suggested creating a mechanism for 'auto-enrollment' incoverage, although such approaches would be operationally andtechnically complex to administer and raise other concerns (e.g.,data privacy).”
|Hearings
AHIP submitted its statements as congressionalcommittees scheduled several hearings on issues related tohealth insurance and the Affordable Care Act (ACA).
|The House Energy and Commerce health subcommittee looked onWednesday at the possible effects of the Texas v. United Stateslawsuit, which could invalidate all of the ACA, on people withpreexisting conditions.
|The House Education and Labor Committee held aseparate hearing on Wednesday on threats to workers withpreexisting conditions.
|The House Appropriations labor, health and human servicessubcommittee held a hearing Wednesday on the policies of theadministration of President Donald Trump that affect the AffordableCare Act.
|The Senate Health, Education, Labor and Pensions Committee helda hearing Tuesday on how primary care affect health care costs andoutcomes.
|Outreach and advertising numbers
Joshua Peck, co-founder of Get America Covered, an organizationthat helped promote the ACA public exchange program, testified atthe House Appropriations subcommittee hearing about the effects ofTrump administration marketing spending cuts on ACA exchange planenrollment activity, and the overall U.S. uninsured rate.
|The Trump administration has cut exchange program outreach andadvertising spending by 90%, or $90 million, Peck said, accordingto the written version of testimony.
|Peck said he believes that reduction inspending on outreach and advertising has cost ACA exchange planissuers at least 2.3 million enrollments.
|That figure implies that the outreach and advertising costs ofgetting those people covered through the exchange system might haveaveraged about $39 per person.
|Covered America found, when it conducted experimentsfor the ACA exchange program enrollment period for 2017, thatpeople who received any outreach email were 18% more likely toenroll than people who had received no email.
|“Sending an email is free, so this outreach is highlyeffective,” Peck said.
|He said Get America Covered found that the cost of generating anexchange plan enrollment, or coverage renewal, through TVadvertising appeared to be about $29 per enrollee.
|“The private sector typically spends between $250 and $1,000 perenrollment,” Peck said.
|ACA effects on overall U.S. health care cost growth
Aviva Aron-Dine, a vice president at the Center on Budget andPolicy Priorities, said at the House appropriations subcommitteehearing that the ACA has probably contributed to the overallslowdown in U.S. health care spending, by having “spillover”effects on health care cost growth in markets other than theindividual major medical markets; by encourage hospitals to bringdown their patient readmission rates; and by creating new Medicarepayment reform experiments.
|The payment reform efforts at Medicare have helped catalyzesimilar efforts by private insurers and employers, and by stateMedicaid programs, Aron-Dine said.
|Telehealth, AI and on-site clinics
Tracy Watts, the national leader for U.S. health carereform at Mercer, talked at the Senate HELP primary care hearingabout Mercer's views on topics such as telemedicine and on-site clinics.
|Watts cited survey figures suggesting that about 16% ofconsumers would consider getting an annual physical exam through atelehealth system, about 9% would consider getting an annualphysical exam by interacting with an automated “artificialintelligence” system.
|In a discussion of worksite clinic programs, she reported thatclinics had a health care return on clinic program investments of3.1 to 1, and productivity improvement of 3.9 to 1.
|The worksite clinic programs reduced spending on short-termdisability for participants who sought medical services, and on thefrequency and duration of long-term disability claims. Watts said,according to the written version of her testimony.
|Resources
Links to House Energy and Commerce health subcommittee Texas v.U.S. hearing resources are available here.
|Links to House Education and Labor Committee preexistingconditions hearing resources are available here.
|Links to Senate Health, Education, Labor and Pensions Committeeprimary care hearing resources are available here.
|Links to House Appropriations labor, health and humanservices subcommittee ACA hearing resources are available here.
|Read more:
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Allison Bell
Allison Bell, ThinkAdvisor's insurance editor, previously was LifeHealthPro's health insurance editor. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached at [email protected] or on Twitter at @Think_Allison.
