PA-NABIP Pulse February 2024

PA-NABIP Pulse February 2024

The Facts of the Month

Here is something to mention when discussing coverage trends in the month ahead.

Prescription drug costs are a top concern for the American public. While retail prescription drugs represent less than 10% of total U.S. health spending and are not the primary driver of the nation’s high health costs, Americans often pay more for the same prescription drugs than people in other countries spend and survey data shows they are unhappy about it. More than six in ten adults (63%) say that drugs developed over the past 20 years have improved the lives of Americans, though an even larger majority (82%) say drug prices are unreasonable. That may explain why majorities of Republicans, independents and Democrats say there is too little regulation of drug prices and support a wide range of policy actions to rein them in.

Source: Kaiser Family Foundation Health Tracking PollThe Big Three

Each month GPAHU identifies three top public policy or legal developments that could impact our members and clients. Here are this month’s big three!

  1. Pennsylvania Insurance Department Makes Licensing Both Easier and Cheaper

To make the insurance licensing process more accessible and less burdensome, the Pennsylvania Insurance Department (PID) recently announced major program enhancements and fee reductions. As of January 1, 2024, anyone seeking licenses through the PID can now submit any of their forms online, and new applications and information materials are being used which include clarifying information for applicants and enhanced instructions.

Furthermore, the PID has removed the $25 processing fee previously charged to make any of the following licensing changes:

  • Add or Remove Designated Licensee or Surplus Lines Affiliation
  • Add or Remove Self Storage Service Location
  • Add or Remove Fictitious or DBA Name
  • Address Change Form for Business Entity
  • Name Change form for Business Entity
  • Name and Address Change for Individual
  • Letter of Clearance or Voluntary Surrender Request

To encourage more people to seek insurance licenses, examinations are now available in Spanish and Chinese. The PID has also reduced the time it takes to review pending applications. By increasing their licensing staff, and by receiving background checks

electronically, the PID can now process applications in eight days or less, down from the previous average of 20 days.

  1. Medical Debt and Enhanced Pennie Subsidy Proposals Feature in Governor Shapiro’s 2024-2025 Budget Proposal

On February 6, 2024, Pennsylvania Governor Josh Shapiro released his proposed budget for 2024-2025. On the health front, in addition to proposing $100 million for significantly more school and county-based mental health resources, Governor Shapiro’s budget request included plans to create a new program to provide medical debt relief to Pennsylvanians and the intent to spend $50 million to further subsidize health insurance premiums for low-income customers of Pennie, the Commonwealth’s health insurance exchange marketplace.

The new medical debt relief initiative would cost $4 million and according to the proposal, the state would partner with a to-be-determined organization that purchases medical debt in bulk, eliminating patients’ responsibility for paying it off. Pennsylvanians with family incomes below 400% of the federal poverty level and to people whose medical debt exceeds 5% of their household income would be eligible to apply for debt elimination assistance. Estimates indicate a $4 million investment by the Commonwealth could lead to forgiveness of as much as $400 million in the medical debt held by approximately 25% of Pennsylvania residents.

  1. New Federal FAQs on ACA-Related Policies

Federal policymakers recently released two new sets of FAQ-style guidance related to Affordable Care Act (ACA) policy issues. The first involves the ACA’s preventive care requirements and updated policy regarding first-dollar coverage of contraceptives. The second addresses the ACA’s premium tax credits and how eligibility may relate to the affordability of employer coverage for both eligible employees and their family members.

The new contraceptive coverage FAQs addresses the ACA preventive care requirement of providing adolescent and adult women access to the full range of contraceptive care approved by the Food and Drug Administration (FDA). Non-grandfathered health plans must cover at least one form of contraception listed in each category of the FDA’s Birth Control Guide (with the exception of sterilization surgery for men), as well as any additional contraceptives approved, cleared, or granted by the FDA determined to be medically appropriate for the individual. A plan can impose medical management or cost-sharing on some forms of contraceptives within a category, as long as they cover at least one therapeutic equivalent in the category on a fist dollar basis. However, if a plan decides to do this, and not just cover all contraceptives in a category first-dollar, then they must make an exception process available. That way, if it is medically necessary for a woman to have access to a particular birth control method or product, she will still have an opportunity to access it free of charge.

The updated premium tax credit eligibility FAQs provide more information about how exchange market tax credit eligibility for dependents who have been offered group coverage works and does not work. For example, they specify that even if a dependent has one offer of employer coverage that is “unaffordable,” but has any others that are “affordable”, then they are not eligible for a premium tax credit. In addition, the new guidance provides updated information about reporting, claiming, and reconciling premium tax credits on personal income tax returns and new information about the impact of unemployment compensation on tax credit eligibility.

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!

The Alliance for Health Reform’s Health Policy Handbook is designed to serve as a primer for anyone who is interested in a quick-study of the key foundations of health policy. This Handbook features a collection of six chapters, each devoted to one core health policy topic and supplemented by extensive resource lists.

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