U.S. Capitol building in Washington, D.C. October 9, 2016.

U.S. health insurers' biggest trade group has told Congress that health insurers want help with continuing to protect the ability of Americans with pre-existing health conditions to get access to affordable health coverage.

America's Health Insurance Plans (AHIP) delivered that message in written statements submitted to the House Energy and Commerce health subcommittee and to the House Education and Labor Committee.

“Americans with pre-existing conditions should be protected,” AHIP said in the statements. “The position of health insurance providers 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 of affordable coverage because of their health status.

AHIP told members of Congress that it believes Congress can help preserve insurers' ability to offer affordable coverage on a guaranteed-issue basis by:

Maintaining a healthy insurance public exchange system, to help consumers shop for coverage.
Maintaining premium subsidy programs, to ensure that low-income and middle-income people can pay for coverage, and keep healthy people in the market.
Maintain and strengthen the current open enrollment period and special enrollment period systems, to discourage people from waiting 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 when they expect to need expensive medical care.

AHIP said that the Affordable Care Act “individual mandate,” or provision requiring many people to have what the government classifies as solid major medical coverage, is one type of continuous coverage policy approach.

“Other policies for promoting continuous coverage before individuals become ill or injured include premium surcharges (or limitations on the availability of premium tax credits), limited plan choices, or waiting periods,” AHIP said. “Some policy analysts have also suggested creating a mechanism for 'auto-enrollment' in coverage, although such approaches would be operationally and technically complex to administer and raise other concerns (e.g., data privacy).”

Hearings

AHIP submitted its statements as congressional committees scheduled several hearings on issues related to health insurance and the Affordable Care Act (ACA).

The House Energy and Commerce health subcommittee looked on Wednesday at the possible effects of the Texas v. United States lawsuit, which could invalidate all of the ACA, on people with preexisting conditions.

The House Education and Labor Committee held a separate hearing on Wednesday on threats to workers with preexisting conditions.

The House Appropriations labor, health and human services subcommittee held a hearing Wednesday on the policies of the administration of President Donald Trump that affect the Affordable Care Act.

The Senate Health, Education, Labor and Pensions Committee held a hearing Tuesday on how primary care affect health care costs and outcomes.

Outreach and advertising numbers

Joshua Peck, co-founder of Get America Covered, an organization that helped promote the ACA public exchange program, testified at the House Appropriations subcommittee hearing about the effects of Trump administration marketing spending cuts on ACA exchange plan enrollment activity, and the overall U.S. uninsured rate.

The Trump administration has cut exchange program outreach and advertising spending by 90%, or $90 million, Peck said, according to the written version of testimony.

Peck said he believes that reduction in spending on outreach and advertising has cost ACA exchange plan issuers at least 2.3 million enrollments.

That figure implies that the outreach and advertising costs of getting those people covered through the exchange system might have averaged about $39 per person.

Covered America found, when it conducted experiments for the ACA exchange program enrollment period for 2017, that people who received any outreach email were 18% more likely to enroll than people who had received no email.

“Sending an email is free, so this outreach is highly effective,” Peck said.

He said Get America Covered found that the cost of generating an exchange plan enrollment, or coverage renewal, through TV advertising appeared to be about $29 per enrollee.

“The private sector typically spends between $250 and $1,000 per enrollment,” Peck said.

ACA effects on overall U.S. health care cost growth

Aviva Aron-Dine, a vice president at the Center on Budget and Policy Priorities, said at the House appropriations subcommittee hearing that the ACA has probably contributed to the overall slowdown in U.S. health care spending, by having “spillover” effects on health care cost growth in markets other than the individual major medical markets; by encourage hospitals to bring down their patient readmission rates; and by creating new Medicare payment reform experiments.

The payment reform efforts at Medicare have helped catalyze similar efforts by private insurers and employers, and by state Medicaid programs, Aron-Dine said.

Telehealth, AI and on-site clinics

Tracy Watts, the national leader for U.S. health care reform at Mercer, talked at the Senate HELP primary care hearing about Mercer's views on topics such as telemedicine and on-site clinics.

Watts cited survey figures suggesting that about 16% of consumers would consider getting an annual physical exam through a telehealth system, about 9% would consider getting an annual physical exam by interacting with an automated “artificial intelligence” system.

In a discussion of worksite clinic programs, she reported that clinics had a health care return on clinic program investments of 3.1 to 1, and productivity improvement of 3.9 to 1.

The worksite clinic programs reduced spending on short-term disability for participants who sought medical services, and on the frequency 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 preexisting conditions hearing resources are available here.

Links to Senate Health, Education, Labor and Pensions Committee primary care hearing resources are available here.

Links to House Appropriations labor, health and human services subcommittee ACA hearing resources are available here.

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AHIP emphasizes pre-existing condition protection in letter to Congress

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