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ACR calls on Department of Labor to protect essential health benefits
The American College of Rheumatology has called on the U.S. Department of Labor to reconsider a new proposed rule that could exempt association health insurance plans from essential health benefits requirements, which the group argues could harm patients and jeopardize access to health care.
According to an ACR press release, the proposed rule would allow trade associations to offer health insurance without many of the coverage requirements for small-group plans under the Affordable Care Act.
“The key message here is that they are proposing to allow plans which could deny coverage of treatments and services that people with arthritis and rheumatologic disease rely on,” Angus Worthing, MD, chairman of the ACR government affairs committee, told Healio Rheumatology. “Our patients tend to use multidisciplinary care including physical and occupational therapy, prescription medicines and labs to monitor for drug toxicity, among other things. If these aren't covered, or if out of pocket costs are unaffordable, a typical person with rheumatoid arthritis could experience disease flares that lead to disability and reduced quality of life.”
Worthing added that the ACR “stands ready to work” with the Department of Labor and other agencies in to “ensure our patients can receive high quality care and treatment that they've come to rely on in the era of essential health benefits.”
In a letter to the Department of Labor’s Employee Benefits Security Administration, ACR President David Daikh, PhD, MD, warned that eliminating essential-health-benefit protections would lead to insufficient coverage for patients with rheumatic diseases.
“The ACR is concerned that loosening these consumer protections will reduce our patients’ access to care, either through weaker coverage or by driving up their premiums,” Daikh said in the release. “Our patients require continuous access to specialized care to manage pain and avoid long-term disability. Therefore, it is imperative that the Administration ensures that Americans living with rheumatic diseases be afforded adequate protections under these new rules.”
In its letter, dated March 6, the ACR recommended that the federal government instead take the following actions:
- Prevent association health plans from selecting their own essential health benefits, as it could lead to a “race to the bottom” among insurers who may only seek the lowest allowable coverage levels;
- Protect patients from discriminatory practices, such as insurers discouraging sicker employees from enrolling in their health plans, as well as increased co-insurance and the tiering of high-cost specialty medications;
- Ensure that association health plan networks provide adequate coverage for specialized services, including pediatric rheumatology, particularly in underserved and rural areas; and
- Require insurers to confirm that patients are well-informed of their rights regarding association health plans, and that a fair process is established for appealing coverage decisions.
“The ACR is dedicated to ensuring patients with arthritis and rheumatic diseases have access to continuous, comprehensive, and high-quality care,” Daikh said in the release. “We appreciate the opportunity to offer our input and are ready to work with the Administration and lawmakers to ensure policies are implemented in a manner that protects patient access to critical rheumatologic care and treatments.” – by Jason Laday