Enhancing Access to Quality Care and Coverage

HLC Position:

It has become imminently clear in recent years that there is organized and well-funded opposition to the role the private sector plays in healthcare delivery. HLC has long been a champion for private plans having the opportunity to drive value in the Medicare Advantage (MA), Medicare Part D and Medicaid programs. As we look at how to protect patient access to quality care, it is essential that the private sector not be crowded out by expanding government authority and excessive regulation. While the federal government has an important oversight role, the private sector must have the ability to enhance healthcare for consumers through choice and value-generating competition. Medicaid redeterminations in the aftermath of the COVID-19 public health emergency continue to leave millions of Americans without some form of health coverage. HLC has successfully created greater flexibility for plans to communicate with these individuals and ensure that they understand their options. This progress must continue, particularly as many lose their Medicaid coverage for strictly procedural reasons even though they remain eligible or may have low-cost or no-cost options available through the healthcare Marketplace. Successes in recent years have increased access to mental health and substance use disorder services. It is essential that there be no rollback in access to this care, particularly as behavioral health needs remain prevalent in the population and addiction issues plague many American communities. Telehealth and remote patient monitoring have improved the lives of millions of Americans. HLC works to make telehealth regulatory flexibilities permanent and to ensure adequate reimbursement for these services. HLC continues its advocacy for permanent allowance of prescribing controlled substances via telehealth communications, an essential service for many patients with serious health conditions.

HLC 2023 Activity:

• HLC has supported a Medicare prescription drug coverage program since its inception. This support continued in 2023 through:
  • Distributing the 2023 Senior Satisfaction Survey conducted by Morning Consult on Medicare Part D. Seniors are more satisfied with their Part D coverage than in virtually any year since its inception: 91 percent report they are pleased with their plan and 87 percent say it provides good value. In response to questions related to the Inflation Reduction Act, 67 percent said they want private plans to continue negotiating prices with pharmaceutical companies directly and only 16 percent want the federal government to set prices.
  • Publishing three op-eds, one highlighting the IRA’s impact on innovation and two sharing the results of our 2023 Senior Satisfaction Survey.
  • Moderating a panel, “More Than a List: The Ripple Effect of the Inflation Reduction Act for Patient Access and Part D,” hosted by the Partnership to Fight Chronic Disease.
  • Submitting comments to the Centers for Medicare and Medicaid Services (CMS) in response to their “Initial Guidance for Medicare Drug Price Negotiation Program for Initial Price Applicability Year 2026,” the “Initial Guidance for the Medicare Part B and Part D Prescription Drug Inflation Rebate Program” and the “Medicare Drug Price Negotiation Program Guidance” as part of the implementation of the IRA.
  • Submitting comments to CMS in response to its Medicare Prescription Payment Plan part one guidance, supporting spreading out out-of-pocket costs for seniors.
  • Hosting four Medicare Today Facebook Live events on the 2023 regulatory and legislative agenda, including the implementation of the IRA, one with former House Speaker Newt Gingrich.
  • Administering Seniors Speak Out, posting weekly blogs, with over 45 in 2023 on issues of interest to individuals participating in the Medicare program.
• HLC advocates for greater access to coverage for low-income Americans, particularly those who are or were recently eligible for Medicaid. In 2023 this work has included:
  • Raising the importance, during in-district meetings, of ensuring health insurance coverage during the Medicaid determination process.
  • Engaging with CMS staff regarding expanding the role health plans may play in reducing unnecessary terminations during the unwinding of Medicaid’s continuous enrollment and joining a group letter to the White House Domestic Policy Council requesting that CMS allow states to authorize Medicaid managed care organizations (MCO) to help enrollees complete eligibility determination paperwork.
  • Joining group letters supporting the Medicaid and CHIP Payment and Access Commission’s (MACPAC) ex parte renewal recommendations and encouraging state officials to adopt automatic enrollment policies for individuals who have been disenrolled through the Medicaid redetermination policy and are eligible for zero dollar premiums in the Marketplace but have not signed up.
  • Joining a group letter to CMS requesting renewal data-sharing requirements for states during the unwinding period be expanded and made permanent.
  • Joining the Connecting to Coverage Coalition, a diverse collection of stakeholders partnering to minimize disruptions in coverage associated with the resumption of state Medicaid redeterminations in 2023.
  • Responding to a congressional request for information (RFI) on ways to improve coverage for people dually eligible for Medicare and Medicaid and providing feedback to Senator Bill Cassidy (R-LA) on discussion draft legislation to improve coverage for the dually eligible population.
  • Submitting a response to CMS’s proposed rule, “Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality.”
  • Joining a group letter to CMS in response to the “Ensuring Access to Medicaid Services” proposed rule.
• HLC continues to utilize its advocacy strategy to advance policies that improve mental health and substance use disorder (SUD) treatment, including:
  • Successfully advocating for a version of 2666, the “Electronic Prescribing for Controlled Substances Act” (EPCS 2.0) to be adopted as an amendment to S. 3393, the “SUPPORT for Patients and Communities Reauthorization Act,” during a Senate Committee on Health, Education, Labor, and Pensions (HELP) markup.
  • Providing feedback to the Departments of Health and Human Services (HHS), Labor, and Treasury regarding a mental health and SUD parity proposed rule.
  • Joining a group letter to CMS urging quicker implementation of the Non-Opioids Prevent Addiction in the Nation Act (NO PAIN Act) to provide access to nonopioid pain medication in outpatient surgery centers.
  • Urging the Senate HELP Committee to further examine ways to improve access to mental and behavioral health services.
• HLC has continued its work in support of the Medicare Advantage program in 2023, providing regulatory, legislative, and social media comments. This includes:
  • Submitting comments in response to the CMS “Policy and Technical Changes to the MA and Medicare Prescription Drug Benefit Program Proposed Rule” for contract years 2024 and 2025 and “Advance Notice of Methodological Changes for Calendar Year 2024 for MA Capitation Rates and Part C and Part D Payment Policies.”
  • Joining a group letter to CMS in support of the MA program and a letter expressing concerns with changes contained in the 2024 MA Advance Notice.
  • Meeting with Senate Finance Committee (SFC) member staff to discuss the negative ramifications of the proposed 2024 MA Advance Notice. HLC regional directors urged key Senate offices to contact the White House to ask for a delay in implementation of the MA Part C risk model until its impact on vulnerable beneficiaries could be better understood.
  • Issuing a press release and blog urging CMS to provide adjustments to the proposed MA rate cuts to preserve quality patient care.
• HLC continues to advocate for other ways to increase affordability and access to care and coverage by:
  • Urging CMS not to move forward with its proposal to cut Medicare payment to home health providers by 2.2 percent.
  • Supporting access for seniors to new innovative drugs and medical technologies by submitting comments to CMS in response to its proposed pathway to provide transitional coverage for emerging technologies (TCET) under Medicare and writing a letter in advance of a House Energy and Commerce (E&C) Committee hearing on the topic.
  • Submitting a letter to the House Ways and Means (W&M) Committee supporting H.R. 5688, the “Bipartisan HSA Improvement Act,” and H.R. 5687, the “HSA Modernization Act,” in advance of a markup where both bills were reported out of committee.
  • Joining a group letter in support of R. 1770, the “Equitable Community Access to Pharmacist Services Act,” and educating members of Congress about the bill during in-district meetings.
  • Encouraging the Senate (HELP), Committee to prioritize adequate support for Community Health Centers’ long term sustainability.
  • Joining a group letter to House W&M and Education and the Workforce Committees in support of affordable coverage for employees of small businesses in advance of markups and joining a subsequent group letter in support of R. 3799, the “Custom Health Option and Individual Care Expense Arrangement (CHOICE) Arrangement Act,” before a successful House floor vote.
  • Joining a group letter in support of R. 2377/S. 1000, the “Saving Access to Laboratory Services Act.”
  • Submitting comments to CMS on the “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2024 and 2025 and joining a group letter supporting provisions in the 2025 notice that facilitate enrollment.
  • Urging the Senate Special Committee on Aging to permanently extend the Acute Hospital Care at Home waiver