American Kidney Fund 2017 Public Policy Agenda

Each year, the American Kidney Fund (AKF) leadership examines the political and policy landscape and develops a public policy agenda on issues affecting people with kidney disease. Our 2017 public policy agenda has as its first priority changing a federal regulation to require health insurers to accept health insurance payments made by charitable organizations on behalf of patients with chronic illnesses. Charitable premium assistance remains a top priority for the patients we serve.

With “repeal and replace” of the Affordable Care Act (ACA), also known as Obamacare, being at the forefront of President Trump’s agenda, AKF put forth principles that must be included in comprehensive health care legislation. We support provisions such as the prohibition on pre-existing condition exclusions in health insurance, the continued coverage of essential health benefits and adequate premium tax credits.  

We also support higher funding for kidney disease research. Advances made in other diseases such as some cancers, Hepatitis C and HIV/AIDS prove that research does ultimately lead to cures. Greater funding of the National Institutes of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) will lead to a better understanding of why kidneys fail, and from there, new remedies and therapies can be developed.

AKF looks forward to working with kidney patients, their caregivers and their loved ones to advocate on these vital issues. If you want to be a part of our Advocacy Network, please click here. To read our 2017 public policy agenda, please click here.

Meet the New Leaders of HHS and CMS

Former Congressman and House Budget Committee Chairman Tom Price was confirmed as the new Secretary of Health and Human Services on February 10. Secretary Price, an orthopedic surgeon, represented Georgia’s 6th District, located north of Atlanta, for 12 years. As Chairman of the House Budget Committee, he wrote a replacement bill for the Affordable Care Act called the Empowering Patients First Act of 2015. Price was also a member of a conservative Republican group called the Republican Study Committee. The group is separate from the House Freedom Caucus, of which Price was not a member, and they opposed his fiscal year 2017 budget resolution.

In March, Seema Verma was confirmed as the Administrator of the Centers for Medicare & Medicaid Services (CMS). She previously served as a health care consultant and worked closely with Vice President Mike Pence during his tenure as the governor of Indiana. Verma is a proponent of applying private-sector strategies to public programs, such as establishing work requirements for Medicaid recipients and the use of Health Savings Accounts. She designed Indiana’s Medicaid program, which requires recipients to pay premiums as well as monetary incentives to encourage people to see their primary care provider rather than going to the emergency room.

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The American Health Care Act -- ACA “Repeal and Replace”

The American Health Care Act (AHCA), the House Republicans’ ACA “repeal and replace” bill, was introduced in early March. The Congressional Budget Office (CBO) estimated that under the AHCA, 14 million people would lose coverage in 2018 and 24 million by 2026.   It would also reduce the federal deficit by $337 billion over the period 2017-2026. Further, CBO says that the AHCA “would tend to increase average premiums in the non-group market prior to 2020 and lower average premiums thereafter, relative to projections under current law. Although average premiums would increase prior to 2020 and decrease starting in 2020…changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules. Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.”

A scheduled House vote in late March on the AHCA was canceled because there were not enough votes to pass the legislation. Congress left Washington for two weeks starting April 10 for a district work period—during which many members held town hall meetings on health care reform. During this work period, another version of the AHCA was negotiated by Rep. Mark Meadows (R-NC) of the conservative House Freedom Caucus, and Rep. Tom MacArthur (R-NJ), of the moderate Republican Tuesday Group that would give more flexibility to states.  While most members of the Freedom Caucus have endorsed this newly amended version of the AHCA, many in the more moderate wing of the House Republican caucus have expressed concerns with it. 

Two main changes to the AHCA are:

  1. Inclusion of a provision that allows states to waive the federal rule prohibiting insurers from increasing premiums for individuals with pre-existing conditions. In order for a state to waive the rule, the state would have to apply for a waiver and create a high-risk pool.
  2. Inclusion of the essential health benefits (EHB), with the caveat that states could receive a waiver if they were able to show that waiving EHB would lower premiums, increase participation, or “advance another benefit to the public interest in the state.”

Republican leadership in the House may bring up this revised bill for a vote the week of May 1. It continues to be unclear if there are enough votes to pass the legislation.

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Renal Medullary Carcinoma Legislation Introduced

Congressman Al Green (D-TX) recently introduced legislation titled the “Byron Nash Renal Medullary Carcinoma Awareness Act of 2017”. This bill encourages efforts to provide education around the risk of renal medullary carcinoma for people with sickle cell anemia. By amending the Social Security Act, this bill would provide states with 50 percent of the funding needed for these efforts. The bill has been referred to the House Energy and Commerce Committee and is currently being reviewed by the Subcommittee on Health.

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Affordable Care Act Market Stability Rule

On April 18, 2017, HHS released a rule entitled the Patient Protection and Affordable Care Act: Market Stabilization. The rule has five major areas that the Trump Administration believes will encourage insurers to continue to sell insurance plans through the market:

  • Shortening the Open Enrollment Period: The open enrollment period for insurance plans starting on January 1, 2018, was November 1, 2017 through January 31, 2018. The rule changes the open enrollment period to November 1, 2017 through December 15, 2017. HHS says this new open enrollment period will serve as an incentive for people to enroll rather than choosing to enroll later if they “learn they will need medical services in late December and January.” HHS believes this will change will influence an individual’s decision to stay enrolled and decrease the incentives for individuals enrolling only after they need health care services. 
  • Increasing Pre-Enrollment Verification: Currently, when an individual needs to enroll in a health plan outside the open enrollment period, it is referred to as a special enrollment period (SEP). Events that would trigger an SEP including moving from another state, losing a job, having a baby, getting married or divorced, etc. Insurers are concerned that people were using SEPs as a way to get enrolled in a health plan when they were sick and needed services, and not because they actually qualified for an SEP. In response, the Trump Administration will now require documentation to verify that an individual qualifies for the SEP. Births will be verified through existing electronic verification methods. For other circumstances, individuals will have 30 days from picking a Qualified Health Plan (QHP) to provide verification documentation to the state.
  • Changing Interpretation of Guaranteed Availability Regarding Unpaid Premiums: The Trump Administration’s rule would allow insurers, subject to state law, to apply a health care premium payments to past debts acquired by not paying previous insurance premiums. The individual’s past debt owed could be from the same insurer or a different—but connected—insurer within a 12-month period. Prior to the change, insurers could only apply a premium payments to an individual’s new insurance. HHS believes this provision will encourage individuals to stay ensured and have “continuous coverage.” Opponents of the rule say that many people believe that can leave their plans simply by not paying, and many consumers do not know that they actually have to alert the insurer to terminate their policies. Additionally, they are concerned that lower-income individuals will not be able to pay both the debt owed and the new payments, which will result in people being uninsured.
  • Lower the Actual Value of the Metal Levels of Insurance: Actuarial value is the average amount that health insurers expect to pay out in claims or, in other words, the percentage of expected health care costs for a specific population. The metal levels are how health insurance plans are organized on the Exchange, and they include Bronze, Silver, Gold, and Platinum. The rule allows insurers to reduce the actuarial value by 2 percent, which means that insurers can cover, on average, 2 percent less than they cover now. The 2 percent reduction would allow insurers more flexibility to design plans, and it would not apply to cost-sharing such as out-of-pocket limits or coinsurance, but it would apply to deductibles. (Coinsurance is a percentage of the costs that individuals must pay. For example, if a patient has a 20 percent coinsurance and the bill was $100, the patient is responsible for $20. A deductible is the amount that a patient must pay prior to the health insurance plan covering most services.) It is expected that the rule will result in deductibles increasing 2 percent.
  • Increasing States’ Role: The rule aims to reduce the regulatory burden on insurers by deferring some federal requirements to the states. One requirement is network adequacy, which required insurers to have a minimum number of doctors and specialists to whom patients could be referred. Requirements for these providers will be reviewed at the state level.

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