More than 1 million people enrolled through the Obamacare marketplaces in the first half of the second enrollment. This strong surge extends from a functional exchange marketplace and a strong belief in the potency of the law. However, there still are some aspects of the law that are confounding shoppers in their search for the health plan. For instance, people with chronic diseases are still being discriminated against in a subtle way, the very thing ACA was created to avoid right from the beginning. This discrimination comes through inadequate information and barriers to care that health plans are erecting for people with preexisting medical conditions.
However with a new CMS rule, things are about to change. The new CMS rule toughens the standards for health plans participating in the exchanges by requiring them to present all crucial information about their plans. The new requirement is targeted at making health plans more transparent, medications more accessible and healthcare barriers more ineffectual. Let’s take a look at the three improvements this new rule brings.
1) More information about the plans – When people are shopping for health plans, they are frequently frustrated by the lack of easy access to most important information about the plans, including information about medications, doctors and hospitals. With the new rule, insurance firms will have to provide all this critical information, on separate website if needed, to give completely accurate drug information and provider network details. CMS might also take this a step further by requiring health plans to fill a standard template of information that exposes all the necessary loopholes in the information and requires health plans to provide all of that information in a single, handy format that can be read by machines for processing through consumer specific tools that assist decision making.
2) Access to affordable medication – Other than lack of complete information about plan coverage, enrollees with chronic diseases are also perplexed with the problem of finding affordable medication. Currently, most health plans partake in the practice of designing a drug formulary that keeps specialty drugs required by people with chronic diseases at the highest cost sharing level. This practice is currently gathering more steam across health plans, with as many as 41 percent of the Silver plans doing this in 2015, as compared to only 27 percent in 2014. Under this new rule, the states will be required to review these changes to check if the health plans are providing affordable care as they should be. The Department of Health and Human Services will also be participating in this review. Under the rule, health insurers will also be prohibited from changing this drug level design in the middle of the year, thereby preventing health plans from denying coverage to people who purchased health insurance precisely to cover these drug costs.
3) Extended support to patients who switch health plans – Currently, when patients change their health plans, they are faced with cost and health challenges as they are unable to continue their treatment routine and meet costs while searching for a new provider who will take over their health coverage. This new rule from CMS makes sure that when patients move from one plan to another, the new insurer covers all care and medication cost for 30 days, even if the prescription drugs do not fall under the plan’s drug formulary. This new concept, called ‘transition care’, is gaining ground, with the administration pushing for as long as 90 days of complete cover. For people with chronic conditions, these cost sharing mechanisms are an impediment to quality healthcare access, and the CMS wants to complete do away with it.
With this proposed rule, the Obama administration is sticking to its original commitment of making healthcare affordable for people with preexisting conditions. Although the rule is not finalized yet, it is set to make an ocean of difference in the quality of healthcare and associated costs for people with chronic conditions under ACA. The health plans might show some resistance to the passing of this rule, but once done, the rule will bolster the continued support Obamacare is receiving from people with chronic medical conditions.