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Aimed Monthly, Volume 1, Issue 12

Welcome to Volume 1, Issue 12 of Aimed Monthly! In the final 2019 issue of Aimed Monthly, we are pleased to present a survey report assessing employer priorities when selecting health benefits, complaints sent to insurance commissioners regarding health plan discrimination against health care providers, and an update on the lawsuit challenging the constitutionality of the Patient Protection and Affordable Care Act (ACA). Start reading below!


Surveying Employers
On December 13, 2019, Aimed Alliance published a report titled “Costly Considerations: An Analysis of Employer Priorities When Selecting Health Benefits.” Based on data gleaned from a survey of human resources (HR) professionals, this report reveals what employers prioritize the most during the benefit selection process. Additionally, “Costly Considerations” analyzes the degree to which HR professionals are familiar with utilization management techniques and how they can impact their employees’ health. About half of surveyed HR professionals indicated that utilization management strategies have resulted in employees being unable to access treatment under their health plan, which has resulted in them taking extended medical leave or requiring disability benefits. Three-fourths of surveyed HR professionals indicated that their health plans include copay accumulators, and two-thirds of surveyed HR professionals indicated that their health plans allow formulary changes in the middle of the plan year. While 95 percent of HR professionals noted that they offer training or resources to help employees understand their health care benefits, only 43 percent of say that a majority of their employees utilize these resources. Explore additional findings here.
Two Steps Backward
On December 18, 2019, the United States Court of Appeals for the Fifth Circuit issued a long-awaited opinion in the Texas v. Azar, the case determining the fate of the ACA. It ruled that the ACA’s individual mandate is unconstitutional but remanded the case back to the lower court to determine just how much of the rest of the ACA should remain intact. For reference, in 2012, the Supreme Court determined that the individual mandate was a constitutional exercise of Congress’ taxing power. In 2017, Congress enacted the Tax Cuts and Jobs Act, which reduced the penalty for not carrying health insurance to $0. Shortly thereafter, several state attorneys general filed suit in U.S. District Court for the Northern District of Texas, challenging the individual mandate’s constitutionality and argued that it was no longer a tax. They argued that the ACA in its entirety was inseverable from the individual mandate provision, and therefore, must be invalidated in its entirety. The District Court agreed with the defendants. The Appeals Court also agreed that the mandate is unconstitutional but did not rule on the severability issue. This case will likely be appealed to the Supreme Court.
Provider Discrimination Complaints 
On December 6, 2019, Aimed Alliance sent complaints to insurance commissioners in Minnesota, North Dakota, and South Dakota, notifying them of a health plan’s arguably discriminatory practices and urging them to take action to address this issue. Sanford Health allegedly denied claims for medications because the prescriptions were written by nurse practitioners and were not signed by licensed physicians. Yet, state law provides nurse practitioners with prescribing authority. As such, we argued that these denials are inconsistent with state law and may also violate Sec 2706 of the ACA. Section 2706 prohibits health plans from discriminating with respect to coverage against health care providers who are acting within the scope of their license under state law.

Where We've Been

  • Summit on Balanced Pain Management
    • On December 4, 2019, Aimed Alliance Counsel Stacey L. Worthy presented on a panel titled “Breaking Barriers: Access to Patient-Centered Pain Care,” at the Summit on Balanced Pain Management.
  • CA Council of Community Behavioral Health Agencies Retreat
    • On December 9, 2019, Aimed Alliance Policy Advisor Taylor Kelly delivered a presentation titled “Health Policy Update: Exploring Recent Federal Developments, Mental Health Parity, and Utilization Management Policies” at the California Council of Community Behavioral Health Agencies’ Annual Retreat.

In Case You Missed It

  • Cardiovascular Disease Webinar
    • On December 10, 2019, Aimed Alliance and the Alliance for Patient Access jointly hosted a free webinar titled “Providing Quality Benefits for Employees with Cardiovascular Disease and Other Conditions.” This webinar examined the economic burden of cardiovascular disease in the workplace and ways to reduce it. Additionally, this webinar discussed the importance of providing quality benefits for employees to ensure that they are able to receive proper treatment if they are diagnosed with cardiovascular condition. Speakers included Kathy Berra, MSN, NP-BC, FAANP, FPCNA, FAHA, FAAN; Ron Goetzel, Ph.D.; Ryan Gough; Alan Kohll; Lindsay Videnieks; Stacey L. Worthy, Esq.; and John A. Wylam, Esq. You can view a recording of the webinar here.
  • New York Step Therapy Meeting
    • On December 11, 2019, Aimed Alliance hosted an event in New York, NY, titled “A Path Forward for New York Step Therapy: An Advocacy Roundtable to Protect Patient Access.” This event featured a collaborative discussion on how to improve the framework and enforcement of New York’s step therapy law. This event included a summary of patient and consumer protections that are currently enacted in New York, an overview of a forthcoming survey from Aimed Alliance,  presentations from advocacy leaders that have worked to advance consumer protections in New York, a review of advocacy strategies that have been successful in New York, and a roundtable discussion to identify areas of improvement for compliance with New York’s step therapy law.
  • Kentucky & CMS
    • On December 16, 2019, Kentucky Governor Matt Beshear withdrew the state’s application to implement work requirements in its Medicaid program. Kentucky was the first state to receive approval from the Centers for Medicare & Medicaid Services (CMS) to impose work requirements on enrollees as a condition of maintaining Medicaid coverage. However, the policy was halted after a federal judge found that the work requirements were contrary to the statutory intent of the Medicaid program. Gov. Beshear also asked the U.S. Court of Appeals for the D.C. Circuit to dismiss the appeal from that case because Kentucky would no longer defend the policy in court.
  • Medicare Advantage Plan Study
    • On December 9, 2019, the Duke Margolis Center for Health Policy published a study that discusses the supplemental benefits that are being offered by Medicare Advantage (MA) plans, following a change in the law that permits these plans to offer benefits designed to address enrollees’ overall health. This study found that MA plans are increasingly offering supplemental benefits, and the types of benefits being offered are slowly evolving over time as plans learn from experience what is permissible and what is not. Additionally, the supplemental benefits that MA plans are currently offering are less expensive and less difficult to administer, while more substantial benefits will likely be offered in the future.
Contact Us
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