‘We’re going to continue to advocate for those types of expansion’
Matt Eyles, president and CEO of America’s Health Insurance Plans, talks about Medicaid expansion, paying for telehealth, and other long-term changes that may result from the pandemic.
The insurance industry got some wins in the American Rescue Plan. Where are you focusing your lobbying activities with the Biden administration and Congress going forward?
There were a couple of things that were not included in the latest relief package that were important. We know sequestration is one that’s on the horizon that looks like it’s going to be imminent. That’s an important fix.
In addition, we’ve been focused on Medicare Advantage and some issues with respect to how certain types of telehealth are treated, especially those encounters that are only over the telephone that right now aren’t counting for Medicare Advantage. And we think that’s potentially going to have an impact on benefits and premiums for next year.
(There’s also) prescription drug prices (and) Medicare Part D reform. There’s a whole host of issues we’re going to have to be focused on while we do everything that we can to make sure people get their vaccines as quickly and as equitably as possible.
How are your members working with providers to make sure that people are getting shots in arms? And how are they keeping track of that since members are going to different locations— Walgreens, a hospital, a public health agency.
It is a huge focus area for us right now. (We recently announced) with the Blue Cross and Blue Shield Association a major initiative called the Vaccine Community Connectors to really make sure that individuals, starting with those age 65 and older who live in the most socially vulnerable communities, are getting connected. We know how challenging it is to get an appointment and get access and we really want to make sure that we’re doing everything we can to help overcome any barriers to get to appointments.
So for example, if someone might need access to transportation or a ride to get there; doing a lot of proactive outreach and making sure that people know that it’s their turn (to get a shot) and that it’s available to them.
We do know that supply is definitely still an issue and the scheduling is still a little challenging, but things are getting better. … We really need to stay focused on making sure that everyone gets vaccinated as quickly and as equitably as possible.
Data access … is a challenge. And that’s an area where we are strongly trying to work with states, to work with the federal government and other partners to make sure that we can get access to the state immunization information systems so we know when people are getting vaccinated and that we can make sure they’re getting their second dose, and as we think about longer term, if there have to be boosters.
Insurers have jumped back into the Affordable Care Act exchanges after a period of time when they were withdrawing from those markets. What’s behind that renewed interest?
It’s amazing how resilient the Affordable Care Act marketplaces have been over time given the challenges when you think back to the launch a little more than half a decade ago. The resilience has been around the innovation with respect to how benefits are being offered, the ability to offer lower-premium plans as we went from silver loading and now into new premium subsidies that are available. I think we’re going to see continued growth.
We were very supportive of the special enrollment period (put in place by the Biden administration) and making sure that people had access to coverage. And I think as the provisions with respect to the American Rescue Plan are implemented, we’re going to see continued interest in growth in the exchanges. This is a time period when it will be important to get as many people covered as possible and hopefully we can build on that and make some of those changes permanent over the long run.
The American Recovery Plan also has funding to encourage states that haven’t expanded Medicaid to do so. What are you hoping to see on that front?
We would like to see the remaining states take advantage of the Medicaid expansion. We know how important it is for those individuals who don’t qualify for exchanges, that coverage gap that exists in so many of those states.
We’ve seen reports from Wyoming, Alabama. We’ve seen some of the ballot initiatives in states like Missouri that have passed recently, and others.
It’s good for consumers, patients. It generally has the support of the population in those states. And now the additional incentives that are available make it a very attractive option.
And people often forget how long it took for the original Medicaid program to be taken up across all the different states. Hopefully it won’t take 17 years like it took for the original Medicaid, but we’re going to continue to advocate for those types of expansion to make sure people have access to coverage.
On the policy side, what we would hope is that over the long term, that some of the issues that weren’t addressed directly around Medicaid in the rescue package—for example, an additional bump in the matching rate—might be able to be put in place … so that there is (a) counter cyclical protection for Medicaid as you see an economic downturn.
Where do you think the equilibrium is for telehealth going forward in terms of a reimbursement structure that works for both insurers and for providers and, ultimately, patients?
The way that we see telehealth becoming sustainable and probably reaching equilibrium over the long term is by providing for flexible benefit design and not having overly prescriptive reimbursement requirements. We don’t think that mandating parity is the right answer, but making sure that there’s flexibility in there.
I think making sure that, with respect to telehealth, that it is treated on equal footing for other purposes, whether it be network adequacy, risk adjustment, and other quality metrics as well. We know that telehealth is here to stay. It’s just a question of is it going to be a third of visits going forward? Or is it going to be 10%? I don’t think we really know the final answer, but I think the indications are people are highly satisfied with telehealth. Especially if you think about services that have been so difficult for so many to access, such as behavioral health and finding providers, that it really has been a lifeline for so many individuals being able to get increased access to treatment and services, especially during the pandemic.
Do you think it comes down to individual contract negotiations as opposed to one-size-fitsall from Washington?
That’s a good characterization of it. (Whether it is from) Washington or from state capitols— because we do know the states still play such an important role when it comes to the regulation of health insurance markets and coverage—it shouldn’t be one-size-fits-all because it is very different depending on the modality, how many patients they’re able to see and whether it’s primary
n care or specialist care.
“We know that telehealth is here to stay. It’s just a question of is it going to be a third of visits going forward? Or is it going to be 10%?”