I Am Essential Coalition Urges Administration to End Discrimination in Health Insurance Exchanges

Yesterday, the I Am Essential coalition sent a letter to Health and Human Services (HHS) Secretary Sylvia Matthews Burwell to highlight on-going beneficiary concerns in implementation of the Affordable Care Act (ACA) ahead of the Administration's final review of 2017 Qualified Health Plans (QHPs) and its release of the proposed 2018 Notice of Benefit and Payment Parameters (NBPP) Rule and Letter to Issuers.

"While beneficiaries have witnessed some improvements, greater enforcement is still needed to ensure that the strong non-discrimination patient protections contained in the ACA are realized, particularly for those with chronic and serious health conditions," said Carl Schmid, Deputy Executive Director of The AIDS Institute. "We are urging HHS, as they conduct their final review of the 2017 QHPs, that it not certify plans that use discriminatory benefit designs that preclude patients from treatment through limited formularies and high cost-sharing."

"Additionally, as the Administration prepares to issue its last significant regulation that will govern the 2018 QHPs, we are urging them to reiterate and expand on the important patient protections currently in place by better defining discriminatory plan design and to enforce them in the future," he said.

The coalition acknowledges that some improvements to coverage have been made in response to issues raised by the patient community, but cites a recent study from Avalere Health revealing that coverage gaps continue to exist and plans are still utilizing high co-insurance, adverse tiering, excessive medical management, and other practices that restrict access to treatments patients rely on.

"The analysis from Avalere confirms that there are still many QHPs discriminating against patients with certain conditions through formularies that place many drugs on high cost-sharing or specialty tiers," said Beatriz Duque Long, Senior Director of Government Relations at the Epilepsy Foundation. "There are many plans today that exclude drugs that treat certain types of epilepsy. This is simply unacceptable."

The letter to Sec. Burwell underscores the importance of access to treatments and care for those suffering from chronic and serious conditions in particular, such as cancer, HIV, multiple sclerosis, mental illness, and epilepsy. In order to protect these patients who already face a myriad of obstacles, the coalition is requesting that the 2018 NBPP and Letter to Issuers define discriminatory behavior clearly and in an enforceable manner.

"The objective of the Affordable Care Act is to provide reasonably priced health insurance coverage for all Americans, even those with pre-existing and chronic conditions," said Andrew Sperling, Director of Federal Legislative Advocacy at the National Alliance on Mental Illness. "When insurers place all drugs for certain diseases on the highest tiers, or exclude them all together, they undermine the goal of the legislation and tarnish the important progress we've made for patients."

I Am Essential's letter also asked that insurers in the Marketplace be required to offer standardized QHPs in 2018 and that prescription drug data be included in the risk adjustment program moving forward, which would benefit all stakeholders.

The full text of the letter to HHS Secretary Burwell can be viewed here.