As 2021 gets underway, both federal and state legislative and regulatory changes are expected to modify health plan benefits for Kansans. Below, Blue Cross and Blue Shield of Kansas Vice President of Government and Community Relations, Sunee Mickle provides an update on how a few of these changes may affect our members.
As the largest health insurer in Kansas, Blue Cross and Blue Shield of Kansas (BCBSKS) actively monitors all legislative issues related to health insurance, insurance markets, and our healthcare delivery system – both in the Kansas Statehouse and in Washington, D.C. Less than a month into the new year, 2021 already promises to be one of significant change. Here are the top federal and state issues we are monitoring at BCBSKS:
Federal Coronavirus (COVID-19) Relief: Although Congress passed a bipartisan COVID-19 relief package in December 2020, it was widely anticipated that additional federal support would be necessary in the early months of 2021 to keep American families, businesses, and frontline workers above water through the duration of this pandemic. President Biden offered the first of a two-part emergency COVID-19 relief plan in mid-January. BCBSKS was pleased that the Biden plan includes important policies to lower cost barriers for Kansans in need of affordable healthcare. It expands and increases the value of the Affordable Care Act’s advance premium tax credits to lower or eliminate health insurance premiums and ensure enrollees do not pay more than 8.5% of their income for coverage. The proposal also calls on Congress to subsidize COBRA through the end of September for those who lose employment. These provisions will help expand access to affordable healthcare at a time when both unemployment and COVID-19 cases are surging in Kansas. Discussions regarding additional COVID-19 relief have only just begun in Congress, so it is too soon to know how much of the Biden proposal will remain intact (or if Congress will reach an agreement on any kind of additional COVID-19 relief at all). BCBSKS supports the swift bipartisan passage of a COVID-19 relief package that prioritizes healthcare affordability for families and businesses alike at a time when it has never been more important.
COVID-19 Vaccine Distribution: Two approved COVID-19 vaccines are now available, with additional vaccines in the pipeline. The vaccine initially will be available in extremely limited doses – but will scale up in production as more vaccines are approved. The vaccine will be available to all BCBSKS members – and all Americans – free of charge. Certain vaccine providers may charge an administration fee for giving the shot, but BCBSKS will cover that cost for our members. Any member who receives a bill for the administration fee of the vaccine should submit a claim to BCBSKS. Providers will be eligible for reimbursement for the uninsured population through a federal relief fund. The COVID-19 response effort has been somewhat fluid at both the state and federal levels. BCBSKS will continue to work closely with both state and federal officials to support and expedite vaccine distribution efforts as much as possible. We will keep our members informed as additional strategies or policy changes are announced.
Expanding Telemedicine Access: COVID-19 forced us to adapt to new ways of doing things in all facets of our lives – including new ways to seek non-emergent healthcare amid a pandemic. As a result, the popularity of telehealth grew rapidly over the last year. BCBSKS began covering telemedicine services in 1993, recognizing early the potential of technology to increase healthcare access and affordability for all Kansans. Long before COVID-19, BCBSKS offered patient-initiated telehealth benefits with physicians and mental health providers in all individual and group health plans.
Several rules and regulations were relaxed during the pandemic to make telehealth services easier to access. BCBSKS made these changes early and proactively – prior to government intervention. We plan to keep those policies in place until March 21, 2021. As a “post-pandemic” life begins to emerge on the horizon, some want to make those temporary changes permanent. BCBSKS continues to support telehealth as a delivery model, but we caution against the hasty codification of temporary, pandemic-era policies. It is impossible to develop a successful long-term strategy for telehealth – particularly related to cost, access, privacy, and quality of care – under the extraordinary circumstances and temporary disruptions of the pandemic. Some COVID-era policies will likely make sense post-pandemic, but others need to be responsibly piloted under circumstances that accurately reflect post-pandemic conditions. A thoughtful, strategic, data-driven approach is the only way to provide Kansans with greater access to healthcare services without increasing disparities or making private health insurance unaffordable for individuals, businesses, and municipalities.
Federal Surprise Billing Reform: In 2020’s final days, Congress passed a sweeping piece of legislation that included funding to keep the federal government open, COVID-19 relief, and a variety of other provisions. Wrapped into this legislation was the No Surprises Act, which addresses surprise billing for out-of-network emergency care, certain out-of-network ancillary care services provided at an in-network facility, and any out-of-network care provided at an in-network facility without the patient’s informed consent.
BCBSKS has long advocated for reforms to better protect our members from surprise medical bills. We believe that patients must be protected from receiving a surprise bill when they have done all they can to receive care within their health plan’s medical network. The No Surprises Act is unquestionably the most significant federal healthcare legislation to pass since the Affordable Care Act in 2010. As the rulemaking phase of the new law gets underway, BCBSKS will work closely with federal partners to ensure smooth implementation of the new law in 2022.
Changes to Affordable Care Act: With a new administration up and running in Washington, we will be closely monitoring policy changes in the healthcare space. Given President Biden’s prominent role in the passage of the Affordable Care Act (ACA), we predict regulatory and policy changes to both reinforce the ACA and expand its reach. For example, the Biden Administration is expected to reinstate certain elements of the ACA that were rolled back during the previous administration, such as extending the annual open enrollment period. They will also likely restore funding for community-based navigators and marketing to increase public awareness regarding eligibility for tax credits and subsidies to cover the cost of monthly premiums. Longer term, the Administration will likely review state waivers for non-ACA compliant health plans and explore options for restoring the individual mandate, (which was reduced to $0 in 2017). However, the Biden Administration indicated that COVID-19 response will top the priority list for the foreseeable future, which will likely delay significant action on the ACA or other healthcare reform.