Update from the Cancer Policy Institute

This has been another week of big announcements in Washington, DC and, in particular, the White House. In one day, President Trump both signed an executive order which would expand the use of association health plans and limit protections and announced that he planned to cut the essential subsidy payments to insurers that help Americans afford their coverage. Also, this week the state of Massachusetts filed an amendment to their state Medicaid Waiver, proposing that they be allowed to create a closed drug formulary that will limit the number of drugs to be paid for under the Medicaid plan. This limitation includes drugs that may be approved by the FDA and commercially available and could deny access to new and innovative treatments. Here are the major issues raised this week: The Executive Order and Association Health Plans (AHPs) Association health plans exist as a way for a group of small business to band together to buy insurance and negotiate collectively. For example, Farm Bureaus are made up of many independent farmers who have joined together to buy insurance. Under the ACA, AHPs were held to the consumer protections standards and benefit structure required by the ACA. The executive order expands the authority of AHPs, allowing them to operate across state lines and does not require them to offer the same essential health benefits required of individual or small group plans, completely upending the protections afforded by the ACA. AHPs could create plans with even less coverage and lower costs, which could undermine coverage and protections for people with pre-existing conditions or in need of more robust plans, and could create a situation where patients will experience even higher overall costs. Cost-Sharing Reductions (CSRs) The administration has announced that they will halt federal payments for cost-sharing reductions, a program created by the ACA that helps millions of American families afford health care coverage. The payments, made to insurers to help eligible consumers afford deductibles, out-of-pocket expenses, and premiums, could end immediately, leaving many states to scramble to make up the difference or leave citizens without access to care. Insurance companies have warned for months that the end of CSRs would be grounds for them to leave the marketplace or dramatically hike premiums. 7 million Americans qualified for the CSR last year, many of whom are very sick. This loss could result in premiums that are more costly or elimination of coverage as payers leave the market. Massachusetts 1115 Waiver Amendment 1115 Waivers exist so that states can apply for federal matching funds to test or implement coverage approaches to the Medicaid program that do not meet federal requirements. Massachusetts has submitted a request to amend their 1115 waiver to include the creation of a drug formulary. Massachusetts has proposed that they be allowed to create a closed formulary to limit what drugs they will cover in an effort to lower their expenses. The limitations of this formulary would reduce the number of drugs covered, and could deny patients access to new and innovative therapies even if there is an FDA approval in place. There will be conditions to protect patients, but this plan creates new requirements to prove the necessity of medications, and could ultimately deny patients access to some treatments.   None of these changes can happen overnight. The Executive Orders direct the Departments of Health and Human Services, Labor, and the IRS to review the order and create a plan of implementation, including allowing time for public comment and changes to the rulemaking. There is also time for Congress to alternatively fund the cost-sharing reductions. Your advocacy has been so important thus far, and your voice has mattered every step of the way. We will continue to keep you up to date as these proposed changes move forward, and make you aware of every opportunity to make your voice heard so that no one is denied comprehensive, quality, and affordable coverage because of their pre-existing conditions, geographic location, or economic status.  Sincerely, Elizabeth Franklin ​Senior Director, Policy and Advocacy ​Cancer Support Community