ACHP Suggests Regulatory Steps To Extend Coronavirus Coverage

In the wake of major legislation including the Families First Coronavirus Response Act, there are still opportunities for Congress to step up its financial assistance for employers, employees, uninsured, and vulnerable populations, the Alliance of Community Health Plans (ACHP) argued in a letter to congressional leaders.

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“As you know, significant changes to an individual’s coverage can have as much impact as not having it at all. That is why we urge Congress to focus on maintaining continuity of coverage and care,” the plans initiated their letter.

ACHP mentioned four populations that need federal assistance in ensuring continued coverage and care: the uninsured, employers, employees, and those clinically vulnerable to coronavirus.

For the uninsured, the alliance recommended that the federal government open up a special enrollment period on the federal exchanges. While Congress has taken significant steps to ensure coverage for most Americans, ACHP noted that many of the uninsured do not qualify to enroll in an exchange plan because they do not have a qualifying event, such as a job loss.

Employers also need relief from the high costs of covering employees’ coronavirus-related costs. Offering a premium grace period as well as premium protection would go a long way in providing enough margin for employers to catch up with payments.

The grace period would include government reimbursement if the employer cannot meet their premium at the end of the allotted extension, while premium protection would offer even more immediate support by providing funds to help cover premiums.

ACHP suggested expanding the healthcare tax credits program and injecting new funds into COBRA subsidies in an effort to assist employees. Both programs cover a portion of premiums for employees who have lost their jobs.

Vulnerable populations are largely centralized in Medicaid and Medicare programs. A Medicaid stabilization fund would provide more funds to states that are seeing escalating enrollment and Medicaid spending, ACHP’s letter stated. Medicare and Medicare Advantage should also be receiving the same flexibility and funding increases.

Medicaid is not the only market that would benefit from market stabilization assistance, ACHP added.

Retroactive risk corridors could help both ACA exchange and Medicare Advantage plans. Risk corridors can help keep cost-sharing and premiums level for consumers in the face of unexpected, widespread healthcare spending.

A reinsurance pool for coronavirus patients cover patients’ costs so that these would not end up leading to insupportable out-of-pocket healthcare spending for employers, patients, and patients’ families. Such an approach would be geographically agnostic, a crucial benefit to this approach since certain locales are much harder hit than others and need more concentrated resources.

The plans emphasized that they were also taking action during this time. ACHP pointed out measures that health plans have already taken to protect their communities, including but not limited to:

• Initiating the nation’s first coronavirus vaccine trial, developing one of the first tests, and designing an emergency ventilator prototype
• Waiving cost-sharing for telehealth and out-of-network visits, regardless of whether or not they were coronavirus-related
• Serving healthcare professionals by making protective gear

“We recognize there is no easy fix to this crisis,” the plans admitted. “We continue to hear daily from our members about the severe toll COVID-19 is having on their communities and their businesses. We must continue to work together to protect Americans as they face significant obstacles to the continuity of coverage and care.”

These recommendations coincided with CMS guidance for private health plans following major coronavirus relief legislation.

The legislation requires private payers to cover a wide range of procedures and items from urgent care visits to coronavirus antibody testing and much more.

While most health plans fall into the categories that must comply with these regulations, the guidance also highlighted a couple of exceptions, including short-term limited duration health plans for which the Trump administration was a strong advocate.