Dental Coverage Legislation

Senators Pat Roberts (R-KS) and Michael Bennet (D-CO) introduced bipartisan legislation to clarify that people outside the public exchanges can have the same choices for dental coverage as people inside the public exchanges. The Aligning Children’s Dental Coverage Act (S. 3244) is a companion to HR 3463, sponsored by Representatives Morgan Griffith (R-VA) and Diana DeGette (D-CO).

Inside the exchanges, parents can pick stand-alone dental benefits for their children as an option. About 99% of Americans select dental coverage separately from their medical coverage. But, outside the public exchanges, the Affordable Care Act isn’t clear on whether families can purchase stand-alone dental plans as part of the required pediatric dental care benefit. As a result, individuals, employers, and carriers are confused about what coverage options are available.

Jason Daughn, vice president of government relations for Delta Dental Plans Assn. said, “The Senate and House legislation offers a simple, but crucial solution to ensure that families across the nation continue to have the access they need and the choices they deserve in obtaining dental benefits. This is a common sense solution to an issue that could pose big problems to families and children across the nation.”

Legislation Would Provide Coverage for Alzheimer’s Care Planning

Newly diagnosed Alzheimer’s patients and their caregivers would get comprehensive care planning services under Medicare in a bill reintroduced by Senators Debbie Stabenow D-Mich. and Susan Collins R-Maine and Representatives Chris Smith R-N.J. and Paul Tonko D-N.Y.

The bipartisan Health Outcomes, Planning, and Education HOPE for Alzheimer’s Act H.R. 1559/S. 857 would require providers to document an Alzheimer’s diagnosis in their medical records. Surprisingly, only 45% of people with Alzheimer’s disease or their caregivers say their doctor told them about the diagnosis. In contrast, more than 90% of people with the four most common cancers were told their diagnosis. People with Alzheimer’s or their caregivers are more likely to be told of the diagnosis only after the disease has become more advanced. Studies have shown that there are benefits to early detection and diagnosis including the ability to plan for the future, take advantage of support services, and participate in clinical trials.

Although Medicare provides coverage for diagnostic services, it does not provide coverage for comprehensive care planning following an Alzheimer’s diagnosis.

Legislation Would End Misleading Health Provider Directories

Senator Ed Hernandez, O.D. (D-West Covina) introduced SB 137 to require health plans and insurers to post accurate health care provider directories on their Websites. During last year’s open enrollment, many people had a hard time determining which plans their providers were in and some felt misled by the plans they chose. While this problem is not a new issue, it has garnered significant attention in the media with the implementation of the Affordable Care Act (ACA). The problem was so bad that Covered California had to take its provider search tool off-line and it is not known when it will be reinstated. Many people complained that they were misled about which plans had contracted with their providers. Due to consumer complaints, DMHC surveyed two large California health plans and issued four deficiencies for each plan because providers were listed in error or not available at the listed addresses. The carriers are disputing some of DMHC’s findings.

“In a world where we compel people to purchase health insurance, we must empower consumers to make accurate and informed decisions about the plans and policies they are choosing,” said Hernandez.

Existing California law only requires health plans to provide a list of providers, upon request, that includes which providers have notified the plan that they have closed practices or are otherwise not accepting new patients. The law requires plans to indicate that the list is subject to change without notice. “The California law on the books for provider directories was written in the dark ages of paper directories,” said Betsy Imholz, special projects director for Consumers Union, a division of nonprofit Consumer Reports.

The bill would require the provider directories to indicate if the provider or staff speaks any non-English language. California consumers come from diverse backgrounds and speak multiple languages, said Sarah de Guia, executive director of the California Pan-Ethnic Health Network. This bill will help meet the needs of our diverse communities by helping them identify providers that speak their language. “We don’t allow other products to be sold with an inaccurate listing of ingredients. We can’t have consumers spending significant dollars on premiums for plans with inaccurate listings of their providers. The bill would make sure provider directors are accurate and standardized, so consumers can know what they are buying and make the right decisions,” said Anthony Wright, executive director of Health Access California. The bill is sponsored by California Pan-Ethnic Health Network, Consumers Union, and Health Access California and will be heard in the Senate Health Committee in April.

Arthritis Foundation Urges Support for Legislation

During the California Arthritis Foundation Council’s summit on April 22 to 23, arthritis advocates urged California lawmakers to support AB 889, which would ensure that consumers have timely access to arthritis medications. They also urge support for SB 1052, which would ensure that Arthritis patients have the information they need to make more informed decisions on Covered California health plan options.

Wesley Mizutani, MD of the California Arthritis Foundation said, “Californians living with arthritis and other rheumatic conditions need to know if their prescription drugs are covered by insurance and how much they will cost. For example, a constituent with Ankylosing Spondylitis, a type of systemic arthritis, switched to a Covered California plan that offered her medication. She later discovered that her prescription co-pay increased from $5 a month to $2,000 a month. Without this medication, her condition will likely regress and could result in spinal fusion with total spinal immobility, fusion of shoulders and hips, as well as difficulty in breathing.” For more information, visit www.arthritis.org.

Medicare Legislation Would Prevent Drastic Payment Cuts

President Barack Obama signed into law the Protecting Access to Medicare Act (H.R. 4302). The bill will halt a 24% reimbursement cut to Medicare providers. It will also eliminate the $2,000 deductible cap on small group health plans. Janet Trautwein, CEO of NAHU explains that many carriers have pulled out of Medicare, leaving thousands of beneficiaries in limbo. Addressing the physician payment will avert a similar crisis by ensuring continued access to physician services. The bill also includes bipartisan legislation to repeal the Affordable Care Act’s statutory cap on deductibles for health plans in the small group market; a provision that Trautwein says the ACA’s inflexible deductible caps would force a majority of small group plans to put employees through significant and often higher premium plan re-design, including raising premiums, increasing copays, or stripping benefits to comply with the cap. She said that H.R. 4302 ensures stable and affordable private insurance coverage options and generates significant taxpayer savings.

Legislation Would Tie Subsidies to Cost of Living

U.S. Reps. Mike Thompson (CA-5) and Anna Eshoo (CA-18) introduced H.R. 3986, the Fair Access to Health Care Act. The legislation would tie health insurance subsidies to the cost of living of a geographic area instead of to the national federal poverty level.

Under the ACA, those earning 138% to 400% of the federal poverty level qualify for premium tax credits to purchase health insurance through the exchanges. A person who earning up to $45,960 and a family of four earning up to $94,200 qualify for premium tax credits.

However, the income threshold doesn’t take into account the cost of living in different geographic areas. A family living in New York City or San Francisco is treated the same as a family living in a small town in South Carolina or Texas.

Thompson explained, “In some California cities, the cost of living is far higher than the national average…Some hard working families in high-cost areas like ours don’t qualify for subsides and therefore can’t get affordable insurance. This bill will help make affordable health insurance a reality, no matter where someone lives.”

Under the bill, the federal poverty level threshold will increase proportionally based on an area’s cost of living above the national average. The cost-of-living is determined using the Census Bureau’s Supplemental Poverty Measure. Using this calculation would yield the following results:
• In San Francisco-Oakland-Freemont, Calif., a family of four earning up to $125,757 and individuals earning up to $61,356 could qualify for premium tax credits to purchase health insurance through the ACA’s exchanges.
• In tVallejo-Fairfield, Calif., a family of four earning up to $109,743 and an individual earning up to $53,543 could qualify for premium tax credits.
• In the Napa, Calif., a family of four earning up to $116,808 and individuals earning up to$56,990 could qualify for premium tax credits.
• In the Santa Rosa-Petaluma, Calif., a family of four earning up to $113,746 and individuals earning up to $55,496 could qualify for premium tax credits.

There is precedent for such cost-of-living adjustments. The ACA accounts for the cost-of-living differences in Alaska and Hawaii by using a higher income threshold to determine subsidy eligibility. The Fair Access to Health Care Act would provide similar adjustments to the other 48 states. Individuals and families from low-cost geographical areas would not be affected by this legislation. Those earning up to 400% of the FPL would still be eligible for subsides and no region would see a reduction from their current subsidy level.

Legislation to Eliminate the Health Insurance Tax is Reintroduced

U.S. Senators John Barrasso (R-WY) and Orrin Hatch (R-UT) reintroduced the Jobs and Premium Protection Act (S.603), which would eliminate the health insurance tax included in the president’s health care law.  Senator Barrasso said, “Over the last three years, Americans and small businesses have watched their health premiums increase under the president’s health care law. Now, they’re set to get hit again unless Congress repeals the costly health insurance tax. Small businesses and their employees are the ones who are going to end up paying this unfair tax.”

Senator Hatch said, “American families and job creators can’t afford the cost or consequences of this ObamaCare health insurance tax. Higher insurance costs, fewer jobs and smaller paychecks is not what president Obama promised when he signed the largest expansion of government into law nearly three years ago, but that’s exactly what’s already happening in no small part because of this tax, said. Raising taxes on health insurance can only ever lead to higher health care costs, because the price of the tax will be passed onto consumers. In this economy and with families and businesses struggling to succeed, it’s time we repeal this egregious tax once and for all.” Senators Richard Burr (R-NC), Dan Coats (R-IN), Mike Crapo (R-ID), Jim Inhofe (R-OK), Johnny Isakson (R-GA) and Mike Johanns (R-NE) are original cosponsors of the Jobs and Premium Protection Act.

Self Funded Legislation Is Sidelined

The California insurance commissioner and key legislators moved SB 1431 to inactive status and decided to revisit the legislation in an upcoming special session or in 2013. SB 1431 would have put partially and fully self-funded benefit plans virtually out of reach for the entire California two to 50 market. This retreat comes in response to stiff opposition from the Self Insurance Institute of America, California Health Underwriters (CAHU), and several other organizations and companies. The following is a message from the CAHU, “Our ‘One Voice’ rang loud and true against SB 1431 (De Leon). CAHU was successful in helping to save this valuable option for California’s small business community. By utilizing our new OneVoice Legislative Alert System, CAHU members and their clients were able to reach out to our legislators quickly and effectively.” For more information, visit www.CAHU.org.

Last Updated 06/29/2022

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