Healthcare reform

Senator Jeanne Shaheen (D-NH) and co-sponsor Susan Collins (R-ME) have introduced S. 1269, the INSULIN Act of 2023.

Representative Angie Craig (D-MN) has reintroduced the Affordable Insulin Now Act in the House.

Representative Andy Biggs (R-AZ) has introduced H.R. 107, the Freedom for Families Act, which proposes the following.

• Provide that distributions from health savings accounts (HSAs) during periods of qualified caregiving are not includible in gross income
• Remove the requirement that an individual be covered under a high deductible health plan in order to contribute to an HSA
• Increase the annual contributions limits to $9,000 for single coverage and $18,000 for family coverage

Under the proposal, periods of qualified caregiving are defined as any period during which an individual is on leave or not employed because of the following reasons.

• Birth of the employee’s child and the period required to care for such child
• Placement of a child with the employee for adoption or foster care
• Caring for the employee’s spouse, son, daughter, or parent, because of a serious health condition
• A serious health condition that makes the employee unable to perform the functions of her position
• Certain emergencies as a result of covered active duty or notification of order to covered active duty in the Armed Forces by the employee’s spouse, son, daughter, or parent

The bill has been referred to the House Committee on Ways and Means.

Congress is expected to vote this week on the Consolidated Appropriations Act of 2023 (CAA 2023), which would serve to fund the federal government for a full year. Included in the bill is a two-year extension that would allow high deductible health plans (HDHPs) to waive the deductible for telehealth and other remote care services without causing plan participants to lose the ability to contribute to a health savings account (HSA). 

H. R. 7780, the Mental Health Matters Act, introduced by Representative Mark DeSaulnier (D-CA) in May, has passed the House and has been referred to the Senate Committee on Health, Education, Labor & Pensions. As previously announced, the bill contains a group health plan provision that would amend ERISA Section 502(a) to expand the type of remedy permitted by a civil action brought by the Secretary, a plan participant or beneficiary, or a plan fiduciary to include readjudication of claims and payment of benefits in accordance with plan terms.

Included in the Mental Health Matters Act is a proposal to amend ERISA to provide that any mandatory predispute or coerced postdispute arbitration clause, class action waiver, representation waiver, or discretionary clause with respect to a plan is unenforceable. The bill would also amend ERISA to prohibit any such clause or waiver from being included in a plan document or other agreement with participants. These provisions were originally introduced under H.R. 7740 and announced.

Senator Angus King (I-ME) has introduced the Primary and Behavioral Health Care Access Act of 2022 (the Act). The Act would amend the Employee Retirement Income Security Act, the Internal Revenue Code, and the Public Health Service Act to require group health plans or health insurance issuers to provide three primary care visits and three behavioral health care visits without cost-sharing.

Representative Kurt Schrader (D-OR) has introduced H.R. 8791, the Medicare Enrollment Protection Act of 2022 (the Act). The Act would amend the Social Security Act (SSA) to provide for a special enrollment period under Medicare, Part A (medical insurance) for individuals enrolled in COBRA continuation coverage. The Act would also prevent the increase of premiums in Medicare, Part A, and prevent a group health plan from considering an individual’s eligibility in Medicare, Part B to reduce or eliminate COBRA continuation coverage. In addition, if enacted, the Act would require the Departments of Labor and Health and Human Services to update COBRA continuation notices to include an explanation of Medicare secondary payer rules. 

The Departments of Labor, Health and Human Services and Treasury issued a joint FAQ related to the coverage of contraceptive products as preventive services by group health plans or issuers. The FAQ provides the following:

• Group health plans and issuers are required to cover items or services that are integral to the furnishing of a recommended preventive service. The FAQ clarifies that coverage of anesthesia for a tubal litigation procedure or pregnancy tests required prior to the provision of an intrauterine device would be considered preventive services.

The Department of Health and Human Services (HHS) has introduced a notice of proposed rulemaking implementing Section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in covered health programs and activities. HHS has introduced a final rule twice before but was unable to implement the rule following civil litigation. The proposed rule seeks to clarify Section 1557 by addressing gaps identified in prior regulation, as follows.

The House has passed the Affordable Insulin Now Act (the “Act”) to limit the cost of insulin to either $35 or 25 percent of the plan’s negotiated price, whichever is less. Group health plans or health insurance issuers of group or individual insurance would be required to implement the coverage of insulin products beginning January 1, 2023. In addition, the Act caps the cost-sharing limit under Medicare to $35 in 2023, even if the individual has reached the annual out-of-pocket limit and to $35 in 2024 for those who have not yet reached their annual out-of-pocket limit. The legislation must still pass the Senate before it is enacted.