Community Advocate, 

Your Friday 5 this month comes to you on a Thursday, as we thought people might be busy on the Friday after Thanksgiving with family, leftover turkey, football, or shopping! While we at HFA were grateful for the holiday break, we are now back hard at work, following progress on the tax bill, the 2018 Open Enrollment Period, developments in Medicaid, and more.  Perhaps most notably, the federal tax bill – which would seriously impact the US healthcare system in multiple ways – will go to a vote within days. Please keep reading to learn more about these important policy developments affecting our community.

As always, thank you for playing an active role in this community. Continue to ask questions, be involved, and take action!

As of this writing, the fate of the massive US tax bill is still up in the air. The Senate version of the tax bill includes a provision to repeal the Affordable Care Act’s (ACA’s) individual mandate. Senate leadership added this provision to offset the cost of the bill’s tax cuts, relying on projections that repeal of the individual mandate would reduce federal spending by more than $300 billion over ten years. But repeal of the individual mandate achieves those savings by increasing the number of uninsured Americans, thereby increasing premiums for individual coverage and increasing instability in the individual insurance market. (The individual mandate incentivizes healthy people to buy insurance, which improves the risk pool; eliminating the mandate would lead some healthy people to exit the market, worsening the risk pool and driving premiums higher). For these reasons, healthcare providers, patient groups, insurance companies, and actuaries strongly oppose the tax bill – just as they opposed the various ACA repeal bills considered earlier this year.

Both the House and Senate tax bills contain additional provisions that would also impact our community: eliminating the personal income tax deduction for unreimbursed medical expenses; repealing or scaling back the Orphan Drug Tax Credit; and triggering immediate cuts of $25 billion to Medicare. We will continue to update you on the progress of this legislation.

Open enrollment for Marketplace insurance plans is under way. In many states, there are only 15 days left to enroll!

Just as a reminder, open enrollment is a period each year when health plans accept applications from new enrollees or when enrollees can renew their existing health plans for another year of coverage.

• If you get insurance through your job, check with your human resources department to find out when your company’s open enrollment period begins and ends.
• If you get your insurance through Medicare, open enrollment dates are the same every year: October 15 – December 7.
• If you get your health insurance through the ACA Marketplace, the 2018 open enrollment period is significantly shorter this year.: In most states, the period ends December 15, 2017. It is important NOT to miss the open enrollment period, as opportunities to enroll outside this time frame are limited. This year, it is also more important than ever that Marketplace enrollees DO NOT simply auto-renew their existing health plans, since decisions made in Washington, DC, in the past few months are having complicated effects on insurance costs. For more information on factors to consider as you sign up for insurance in 2018, please read our recent Dear Addy post on open enrollment.
• Medicaid enrollment is 365 days per year based on need and income. 

HFA has recently learned of a new strategy Pharmacy Benefit Managers (PBMs) have implemented, called Accumulator Adjuster Programs (AAP). AAPs are programs PBMs provide, mostly to large employers, that apply to patients who use drug co-pay cards. Under an Accumulator Adjuster Program, a PBM accepts co-pay cards for out-of-pocket costs associated with treatment but then doesn’t credit that amount toward the patient’s overall deductible. This means that patients with chronic and expensive disorders will still be required to pay their overall deductible out-of-pocket. AAPs are particularly troubling because they are most often implemented in self-funded employer plans that have high deductibles. The Integrated Benefits Institute, a non-profit that evaluates health benefits for employers, has warned employers against implementing these plans, citing the long-term high costs of patient nonadherence to therapy. If you have received a letter from your employer or benefit manager stating that your co-pay cards will no longer be applied to your deductible, please inform Project CALLS. Collecting data about these issues is the only way to fight their implementation! 

This fall, the US Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) proposed changes to the federal rules defining “essential health benefits” (the benefits that insurance plans must cover, under the ACA). While the Administration’s stated goal is to enhance state flexibility, the new proposed rules would give states too much leeway to “race to the bottom” in defining weak essential health benefit standards. HFA submitted comments detailing our concerns with the proposed rule. We urged HHS and CMS to recognize that the continuation of patient protections is critical and that health plans must meet the needs of all consumers, including the most vulnerable patients living with rare and chronic diseases. You can find HFA’s comments to HHS/CMS here.

HFA attended the 2017 NAMD Fall conference in Arlington, Virginia. CMS Administrator Seema Verma’s keynote speech made national headlines. In her address, Ms. Verma laid out her plans to “reset the federal-state relationship” and to give states more flexibility in shaping their Medicaid programs – or, translated from Washington-speak: to allow states to pare back Medicaid enrollment and cut costs. Ms. Verma, no fan of the ACA’s Medicaid expansion, argued that Medicaid was not designed to cover working-age, able-bodied grown-ups. She announced that CMS will make it easier for states to change the rules for Medicaid beneficiaries by imposing work requirements, premium payments, or other conditions. Some of these changes would represent a stark departure from longstanding federal policy and will likely face legal challenge. HFA will continue to track these and other developments in Medicaid policy; we will keep you posted as we weigh in on changes affecting our community.

Stay Tuned!

That's all for this month, but remember: every month we're working with our member organizations and strategic partners across the country to improve the lives of those living with bleeding disorders.

We will continue to send you an update on the last Friday of each month summarizing the five things you should know about HFA's advocacy efforts. See you in December!