Like many other patients, women living with heart disease spend countless hours and thousands of dollars on health care costs. Over the past year, Congress has debated several policies to make health care more affordable. Numerous bills have been introduced that would reduce patients’ out of pocket costs and address roadblocks to getting the care providers prescribe. It remains unclear which of these proposals, if any, will ultimately be passed and signed into law. Here’s a summary:
Surprise Billing
Every year, millions of insured patients are hit with “surprise medical bills,” or charges for medical care that result from inadvertently seeing an out-of-network provider. These tend to occur in emergency situations – when the patient is unable to select their emergency room – or when receiving care at an in-network hospital by a provider who happens to be out-of-network.
While several states have worked on laws to address this problem, there is now bipartisan support in Congress to address it at the federal level. Committees in both the House and Senate have passed legislation (H.R. 2328 and S.1895) with provisions to protect patients from surprise medical bills. These bills embody one of the key principles that WomenHeart and partner organizations have advanced when advocating for a solution – they hold patients harmless by requiring health plans and insurers to cover extra charges beyond the in-network level of cost sharing. The sticking point in moving the bills forward is how to resolve payment for surprise bills, with several options relying on some version of a median rate, negotiation process and/or dispute resolution. WomenHeart urges Congress to take action before the end of the year to solve this problem on behalf of patients.
Cap on Medicare Part D Out-of-Pocket Costs
Another policy gaining bipartisan momentum in the House and Senate is out-of-pocket caps for Medicare beneficiaries with Part D coverage, including many women with heart disease. While Medicare Part D prescription drug coverage is broadly popular, challenges remain around access to medications, high costs for some drugs and the fact that many Part D beneficiaries spend thousands of dollars on medication each year.
Various bills in the House and Senate have proposed an annual cap of between $2,000 and $3,100. In addition, changes made to H.R. 3 by Representative Anna Eshoo (D-CA) and a bill (S. 2911) introduced by Senators Bill Cassidy (R-LA) and Bob Menendez (D-NJ) include a “smoothing” mechanism to help Medicare Part D beneficiaries pay in installments rather than all at once, effectively smoothing out high upfront costs over time. WomenHeart has signed a letter to Congressional leaders supporting a cap and smoothing provisions.
Preventive Care for Chronic Conditions
In an effort to reduce financial strain on patients with chronic conditions, including women living with heart disease, Representative Lauren Underwood (D-IL) has introduced the Chronic Condition Copay Elimination Act (H.R. 4457). The bill, endorsed by WomenHeart, would eliminate cost sharing for preventive medications, screenings and care used to treat chronic conditions, including heart disease. The bill would require private insurance plans to provide first dollar coverage for preventive care and services, including ACE inhibitors, beta-blockers, statins for heart disease and other care for conditions including diabetes and hypertension.
Streamlining Prior Authorization
Too often, prior authorization practices create delays in care while providers and patients are working to get insurance providers’ approval for coverage of care. Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Dr. Ami Bera (D-CA) and Dr. Roger Marshall (R-KS) have introduced a bill to address this challenge in Medicare Advantage. The Improving Seniors’ Timely Access to Cares Act (H.R. 3107) would streamline the process of gaining approval for coverage of certain services. It requires Medicare Advantage plans to minimize the use of prior authorization for routine services and for medically-necessary services performed during surgery and invasive procedures, as well as to adopt electronic submission systems and to improve transparency.
WomenHeart will continue to work on these and other policies into the new year – focused on ensuring that women living with and at risk of heart disease can access and afford the prevention, screening and treatment they need to thrive.