RISE summarizes recent regulatory headlines.

Dems call on Biden to reverse Trump final rule and ban ‘junk’ health plans

A group of 42 Democrats in Congress recently urged the Department of Health and Human Services (HHS) and the Biden Administration to reverse the final rule issued by the Trump administration that expanded short-term, limited-duration plans, commonly known as “junk plans” or “skinny plans” because they fail to offer comprehensive health care coverage.

A federal final rule issued in August 2018 allows states to sell short-term plans from 90 days up to 364 days and may be renewed for up to three years. These health plans are often inexpensive but don’t cover as many medical services and can deny coverage to consumers with pre-existing conditions. These yearly, renewable plans also compete with plans that comply with the Affordable Care Act (ACA). In the letter, House Democrats said that their analysis of the junk plans found that 43 percent of plans surveyed failed to cover mental health services, 71 percent of plans didn’t cover outpatient prescription drugs, and no plans covered maternity care.

While the plans serve a purpose for those who need temporary coverage, such as workers who are between jobs and do not elect COBRA, the letter said that they may find themselves with inadequate coverage when they need care.

“Junk plans pose clear risks to consumers, undermine the strength of the ACA, and are incompatible with the goal of making affordable, high-quality health insurance accessible to all Americans,” they said.

The Association for Community Affiliated Plans (ACAP), which represents safety-net health plans, sued in 2019 arguing the rule violated the ACA, but an appeals court in 2020 upheld the sale of the plans claiming that they are neither contrary to law nor arbitrary and capricious.

Feds: Record number of people enrolled in ACA coverage this year

A new report issued by the U.S. Department of Health and Human Services, through the Office of the Secretary for Planning and Evaluation (ASPE), shows that the total enrollment for Medicaid expansion, Affordable Care Act (ACA) marketplace coverage, and the basic health program in participating states reached an all-time high of more than 35 million people as of early 2022. The findings come on the heels of a report from the Centers for Medicare & Medicaid Services (CMS) that shows a record-breaking 21 million people in more than 40 states and territories gained health care coverage due to the ACA’s expansion of Medicaid to low-income adults under 65.

The success of Medicaid expansion nationwide highlights a path to affordable, comprehensive, person-centered care for the 12 states (Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming) that have yet to expand their Medicaid programs. CMS said additional state expansion is key to advance health equity: of the nearly four million uninsured Americans who could gain coverage if these states expanded their Medicaid programs, more than half are people of color. Oklahoma and Missouri, which expanded Medicaid coverage in 2021, saw an enrollment increase of more than 276,300 and 146,600 individuals, respectively.

“Medicaid is a lifeline to better health and care for millions of people—including the millions who gained coverage thanks to expansion under the Affordable Care Act,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “Medicaid expansion is key to improving maternal and infant health outcomes, addressing longstanding health disparities, and connecting people to needed essential care. Nearly four million additional people could benefit from this coverage if Medicaid is expanded in all states. We can’t leave them behind.”

Center for Medicare Advocacy reps call on Medicare to improve access to home health

Misunderstandings about Medicare-covered home health care, along with changes in Medicare payment and regulations, have greatly restricted access to these important services, according to a blog post published on the Commonwealth Fund and written by the Center for Medicare Advocacy’s Judith A. Stein, executive director, and David A. Lipschutz, associate director.

Although the Medicare home health benefit is meant to provide coverage for those with both acute and chronic conditions, changes in Medicare payment, quality measures, and audits to limit fraud have led to misunderstandings about what the law covers, they write. As a result, some home health agencies have restricted services for fear they will be audited or reimbursed.

“The Center for Medicare Advocacy hears regularly from people who meet Medicare coverage criteria but are unable to access home health benefits or denied the appropriate amount of care,” they write in the post.

To restore access to these services, Stein and Lipschutz urge CMS to launch an educational campaign to explain what services are covered and the qualifying criteria.