Access and affordability are the top two concerns of the health insurance industry as we move into a new year. That was the word from Matt Eyles, president and CEO of America’s Health Insurance Plans, during a webinar on “The State of the Industry.”
“Over past three years ago, our health care system has been tested in extraordinary ways no one predicted,” he said. “We embraced telehealth, new technology and new flexibilities to insure people had access to the care they needed. Today we are evolving from the COVID-19 pandemic. Now Americans are calling for public and private sector leaders to come together to make health care more accessible and affordable.”
Other challenges the health insurance industry must address, Eyles said, include an unprecedented workforce shortage in health care, an unprecedented demand for mental health care and increased rates of substance abuse.
“Health insurers look forward to working with government to deliver real solutions to these challenges,” he said.
Eyles pointed to AHIP’s Healthier People Through Healthier Markets initiatives as the association’s road map to improving competition in health care. He provided some results of a recent AHIP study that showed:
78% of those surveyed said they want physicians to be prevented from charging unnecessary administrative fees and markups.
76% want protections against hospitals gaining monopoly power.
75% want consumers defended against paying more for the same treatment.
71% want more transparency around private equity firms acquiring monopoly power over health care.
More support for mental health and substance use disorder
Amid a growing need for mental health and substance use disorder care, AHIP issued a statement of commitment to include:
Helping patients timely navigate to the right practitioner and setting based on their need for support.
Integrating mental health and substance use disorder support with visits to a primary health care provider.
Creating programs to expand system capacity and increase the number of available mental health practitioners.
Expanding access to mental health care through telehealth, virtual visits and other innovative technologies.
Continuing to ensure mental health and substance use disorder treatment is covered on par with physical health treatment in compliance with the Mental Health Parity and Addiction Equity Act.
Making prescription drugs more affordable
AHIP also took aim at the pharmaceutical industry, with Eyles saying “Big Pharma sets and controls and price” consumers pay for drugs. AHIP called for making treatments and therapies more affordable by:
Ending what it called “Big Pharma patient abuse.”
Greater use of generic and biosimilar drugs.
Greater use of specialty pharmacies.
Ending copay assistance and discount coupons, which AHIP called “anti-consumer” and claimed “put more money in Big Pharma’s pocket.”
Concern over data privacy
Data privacy is another of AHIP’s concerns going into 2023, with the association releasing its Roadmap for Protecting Privacy and Security of Consumer Health Information, which states:
Every person should have access to their data and be able to easily know how their health information may be shared.
Personal health information should be protected no matter who holds the data.
Demographic data should be leveraged to improve health equity and outcomes.
Entities offering digital tools should be required to embed consumer privacy and security protections within those tools.
The commercial sale of identifiable health information without the individual’s agreement should be prohibited.
Health care equity
AHIP also will focus on addressing disparities and equities in health care in the coming year, Eyles said.
Health insurance providers are using data to identify and support people most in need of equitable care while preserving consumer privacy. AHIP is collecting and sharing industry actions, gathering and amplifying best practices to better serve and represent various communities.
Keeping Medicaid recipients from losing coverage
Millions of those who enrolled in Medicaid coverage during the COVID-19 pandemic are on the brink of losing that coverage, after the omnibus spending bill enacted by Congress in December changed the enrollment rules.
States that received extra Medicaid funding under a 2020 COVID-19 relief bill had to agree to pause beneficiaries’ eligibility verifications. The continuous enrollment in Medicare was set to end when the public health emergency is over, which is likely to happen sometime in 2023. Known as The Great Unwinding, the undoing of many health coverage requirements and incentives put into place as a result of the COVID-19 public health emergency declaration and related legislation will be undone when the public health emergency is over.
Under the $1.65 trillion federal spending bill approved by Congress in December, states can begin disenrolling people from Medicaid in April even if the public health emergency designation remains in place. Many of those who will lose coverage are likely to qualify for coverage under the Affordable Care Act, according to public-health officials and advocates.
“How do we protect those who have access to health care through their Medicaid coverage?” Eyles asked. He said AHIP is calling for:
Ensuring people who continue to meet eligibility requirements are not disenrolled due to administrative barriers.
Facilitating a smooth transition from Medicaid to other types of coverage, including Affordable Care Act marketplace coverage and employer-sponsored coverage.
Allowing for states to use the full 14 months allotted to them to re-enroll Medicaid recipients, instead of rushing through the process and potentially terminate coverage erroneously for those who are still eligible for Medicaid.
Making long-term improvements to the redetermination process.
“Health care is about serving people and that’s what health insurance providers do,” Eyles said. “We are committed to ensuring Americans live their fullest, most productive lives.”
Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.