New Bill Targets Telehealth Provisions in High-Deductible Health Plans

A new bill before Congress aims to improve telehealth coverage, particularly for primary care services, in high-deductible health insurance plans.

The Primary and Virtual Care Affordability Act (HR 5541), introduced earlier this month by US Reps. Brad Schneider (D-IL) and Brad Wenstrup (R-OH), would extend through 2023 a provision in the CARES Act that established first-dollar coverage for telehealth services in HSA-eligible HDHPs. It would also give HDHPs the leeway to waive the deductible for primary care services.

“Financial burdens should not prevent Americans from seeing their primary care doctor to discuss critical health care needs,” Schneider said in a press release. “The upfront costs of high-deductible health plans discourage too many Americans from getting the preventative care they need, leaving issues untreated and ultimately resulting in higher costs and poorer outcomes down the line.”

Estimates place the number of Americans with HDHPs at more than 35 million – or roughly 30 percent of all covered workers. The plans offer attractive low monthly premiums, but set high deductibles that the plan holder must pay out of pocket before the insurance kicks in.

Telehealth advocates point out that those high deductibles can be barrier to accessing care, particularly for those with limited incomes. The Alliance for Connected Care, which supports the bill, points out that more than half of those with an HSA live in areas where the median income is below $75,000, making it difficult to reach the $1,400 individual and $2,800 family thresholds that trigger coverage.

Recognizing that concern, Congress included a provision in the CARES Act, passed in 2020, that enabled employers to create a safe harbor from certain HDHPs during the pandemic, enabling them to offer free or reduced-cost access to telehealth services. But that provision will end at the end of this year.

“During the COVID-19 pandemic, Congress enabled employers to offer pre-deductible coverage for telehealth services, expanding access to care and reducing out-of-pocket costs for millions of Americans,” the alliance’s executive director, Krista Drobac, said in a press release. “This bill will ensure individuals with HSAs continue to have ready access to virtual-care and primary care services while remaining eligible to make and receive contributions to an HSA.”

The House bill mirrors a similar effort in the Senate.

Last March, Senators Steve Daines (R-MT) and Catherine Cortez Masto (D-NV) introduced the Telehealth Expansion Act of 2021, which would permanently extend that safe harbor in HDHPs. That bill has drawn support from several groups, including the Alliance for Connected Care and the American Telemedicine Association.

“As we emerge from the public health emergency, permanently extending the HDHP/HSA Telehealth Safe Harbor would allow fully half of American workers and families to continue accessing clinically appropriate telehealth and remote care services for a range of common conditions, without the burden of first meeting a deductible,” ATA CEO Ann Mond Johnson said in a press release.