HealthCare Roundtable e-News – May 5, 2021

White House’s American Families Plan Makes Enhanced ACA Subsidies Permanent but Excludes Medicare Expansion

The Biden administration unveiled its American Families Plan last week, a package of legislation that will look to invest $200 billion to make permanent some of the temporary policies passed in the American Rescue Plan. Included in the package is a permanent extension of the Affordable Care Act premium reduction, although notably absent is expanded Medicare coverage, despite pressure from Democratic lawmakers who urged him to extend the program to more Americans.

A White House senior administration official suggested that making permanent the ACA premium reductions provided for two years under the American Rescue Plan is “one of the most impactful investments for reducing costs and making coverage more accessible to the uninsured.” Under the law, enrollees pay no more than 8.5% of their income toward coverage, down from nearly 10%. And lower-income policyholders receive subsidies that eliminate their premiums completely.

The president has also made it known that he remains fully committed to lowering drug costs and working in drug price negotiations. White House officials commenting on the president’s plan added that reducing drug prices will not only provide relief to millions of people but will also generate revenue that can be applied to expanding coverage to those places in the country that have gaps still. Rep. Frank Pallone (D-NJ), chair of the House Energy & Commerce Committee, has already stated that he has plans to include drug pricing in the package, “regardless of what the White House does.” (InsideHealthPolicy)

Senate Finance Committee Chair Ron Wyden (D-Ore.) and Sen. Chuck Grassley (R-Iowa), who had previously advocated for Medicare price negotiations in their Senate Finance drug pricing bill, declined to comment on next steps if the White House did not include negotiations as a part of the American Families package. (InsideHealthPolicy)

Biden’s First Address to Congress Touches on Drug Pricing Legislation, Medicare and ACA Reforms in the Year Ahead

In his State of the Union address to Congress last Wednesday (Apr 28), President Joe Biden called on Congress to pass legislation aimed at lowering drug prices for Americans, an issue backed by both Democrats and Republicans. The president made it clear that his agenda involves the expansion of health coverage beyond the American Rescue Plan; however, the absence of a drug pricing plan in Biden’s American Families Plan released last week has raised questions about Biden’s commitment to moving forward on the legislation.

“Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower prices for prescription drugs. That won’t just help people on Medicare – it will lower prescription drug costs for everyone,” Biden said in his address.

Prior to the president’s address, many progressives in the Senate and some House Democrats pushed Biden to include drug pricing reform in his latest legislative package in an attempt to use the savings to lower the Medicare eligibility age and expand coverage to include hearing, vision, and dental coverage. Biden also gave a nod to his caregiving infrastructure proposal, which would dedicate $400 billion to home- and community-based services. The American Jobs Plan would help these families and create caregiving jobs with higher pay and benefits, and while the American Families Plan does not include drug pricing legislation, House Energy & Commerce Chair Frank Pallone (D-NJ) said that he plans to add drug pricing reforms to the president’s anticipated infrastructure package. (InsideHealthPolicy)

Senate Democrats Look to Expand Medicare Coverage Eligibility to Americans ages 50 to 64 in Reintroduced Bill

Last week, a group of Senate Democrats reintroduced legislation that would expand Medicare coverage to American adults ages 50 to 64. The bill, which is sponsored by Sens. Debbie Stabenow (Mich.), Sherrod Brown (OH), and Tammy Baldwin (Wis.) and supported by 18 other Senate Democrats, would offer an affordable health care option to those preparing, but are not yet eligible, to retire, while still reinforcing the existing Medicare and health insurance marketplaces.

Known as the Medicare at 50 Act, the legislation would give millions of Americans an option to “get the health care coverage they need at a price they can afford,” according to Baldwin, who argued that there is more that must be done to “change the status quo, improve our healthcare system and lower costs.”

Critics of the bill have suggested instead that Congress should be working to strengthen public health programs in the next legislative package, rather than plow all savings into boosting the Affordable Care Act. Insurers, hospitals, and other industry stakeholders have long been lobbying against Medicare for All, or any other public option.

Some research groups have argued that Americans between the ages of 50 and 64 are the least likely of any age group to be uninsured and that lowering the Medicare age could lead to cost shifts and higher private plan premiums. However, Sen. Stabenow suggests that lowering the Medicare age to 50 will give Americans more options, especially those who have been laid off or are forced into early retirement and need coverage. (InsideHealthPolicy)

CMS Rule Keeps Trump Policy Letting Obamacare Plans Undermine Copay Coupons

The Centers for Medicare and Medicaid Services recently announced that it would not be reversing a Trump administration policy on Obamacare coupons. The policy currently lets Obamacare plans prevent brand drug makers’ copay assistance from counting towards enrollees’ deductibles. While Medicare currently bans copay coupons, they are allowed in the commercial market and ACA exchange plans.

Carl Schmid, executive director of HIV+Hepatitis Policy Institute, said that CMS “did not address the comments submitted” by the organization. HIV+Hep is part of a coalition of patients and providers called the All Copays Count Coalition that had been lobbying for a bipartisan bill to undo the copay accumulator policy. The bill had the support of 34 House lawmakers.

“We know that the Biden-Harris administration wants to improve patient affordability of healthcare, particularly for vulnerable communities,” Schmid said. “However, they missed a perfect opportunity to demonstrate this commitment.” (InsideHealthPolicy)