AHIP Packages Healthcare Affordability Recommendations; ACA Enrollment Dips

In the wake of a fierce debate about the cost and access of healthcare during this fall’s midterm elections, the lobbying group for US health insurers released what it said are 12 proposals to help increase affordability for people who buy insurance on the individual market who do not qualify for subsidies.

Separately Wednesday, CMS said 1.2 million people signed up for health insurance during the first 10 days of open enrollment for the individual marketplaces.

Around 13 million people currently purchase their own healthcare coverage through the individual marketplaces set up through the Affordable Care Act (ACA), and 5 million of them do not qualify for tax credits or subsidies, said America’s Health Insurance Plans (AHIP) Wednesday.

AHIP said its proposal is aimed at helping families that make more than 400% of the federal poverty level who fall into a gap. But the group said its proposals could help lower premiums for everyone.

The package, containing many long-standing AHIP positions on healthcare and insurance issues, is aimed at state and federal lawmakers who could affect policy through either legislation or regulation.

An AHIP spokeswoman said in an email the 12 proposals are not directly related to the midterms, but said “the purpose of this paper is to make those recommendations actionable,” especially with new leaders taking over at both levels of government.

Some races are still being decided, like the outcome of Georgia’s governorship and Senate seat, and there were surprises, like Democratic wins in Nevada and Arizona. And this week, the winners of House races came to Washington for orientation as Democrats prepare to take over that side of Congress in January.

AHIP said the report focuses on 3 drivers of rising premiums: too few healthy people in the market, ever-spiraling costs of healthcare and prescription drugs, and a lack of premium savings for families making more than 400% of the FPL.

Some of the proposals are long-standing, like doing away with the health insurance tax created by the ACA; the tax is set to resume in 2020. Other proposals support broader reimbursement and payment for telehealth.

To cut healthcare costs, AHIP wants to reduce surprise billing; curb what it called “inappropriate” third-party premium payments; increase drug competition, especially biosimilars and generic drugs; and increase flexibility for reference pricing.

Meanwhile, the number of individuals signing up for insurance through the exchanges in the first 10 days is about 300,000 fewer than last year, but the current period also reflects 1 less day.

On Twitter, Larry Levitt, senior vice president for health reform at the Henry J. Kaiser Family Foundation, said it is possible the midterms diverted attention away from the sign-up period. He also noted that people who might have enrolled are now eligible for Medicaid instead, like in Virginia, which expanded Medicaid this year.

He said he expects a surge in enrollment right before the period closes on December 15.