RISE summarizes recent regulatory news.

Final rule takes action to resolve ACA ‘family glitch,’ lower health care costs

The Internal Revenue Service (IRS) has issued a final rule that fixes the so-called “family glitch,” a 2013 Affordable Care Act (ACA) implementation rule that based affordability of employee-sponsored insurance on the cost for the employee only and didn’t consider the expense of adding family members to the plan. The new final rule will allow family members who are offered unaffordable employee-sponsored family coverage to be eligible for subsidized marketplace coverage.

The rule is considered the most significant administrative action to implement the ACA since the law was enacted, according to a statement from U.S. Department of Health & Human Services (HHS) Secretary Xavier Becerra. “Protecting and strengthening implementation of the Affordable Care Act is key to increasing access to quality, affordable health care. Today’s action resolves a flaw in prior ACA regulations to bring more affordable coverage to about one million Americans. Our goal is simple: leave no one behind and give everyone the peace of mind that comes with health insurance,” he said.

HHS extends COVID public health emergency

Xavier Becerra, secretary of the Department of Health and Human Services (HHS), has extended the COVID-19 public health emergency (PHE) another 90 days. Becerra renewed the PHE on October 13, which will allow most emergency waivers to remain in place through January 2023.

The emergency declaration allows providers and health plans to respond to COVID-19 by taking advantage of flexibilities, including the waiving of telehealth restrictions.

HHS first declared COVID-19 was a PHE on January 17, 2020, when the pandemic began, and it has been renewed each quarter since then. The government said it will provide states with 60-days’ notice before it terminates the PHE.

The latest renewal comes in the wake of President Biden’s controversial comment that the pandemic is over. However, as of the week ending October 1, the United States had lost nearly 1.1 million lives to COVID-19, including about 790,000 people ages 65 and old. Public health experts attribute increasing cases of COVID to the more transmissible Omicron variant. Other factors include relatively low booster uptake and waning vaccine immunity.

Biden signs executive order to lower prescription drug costs

President Biden on Friday signed an executive order that directs HHS to explore additional actions to lower prescription drug costs. Those actions include leveraging the “Innovation Center” at HHS, created by the Affordable Care Act, which has authority to test new ways of paying for Medicare services that improve the quality of care while lowering costs. 

In the order, Biden said that too many Americans have trouble paying for prescription drugs. On average, Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications.  Nearly three in 10 American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost.

Under the Executive Order, HHS will have 90 days to submit a formal report outlining any plans to use the Innovation Center’s authorities to lower drug costs and promote access to innovative drug therapies for Medicare beneficiaries. This action would build on the Inflation Reduction Act’s landmark drug pricing reforms.