X

Anthem software upgrade caused widespread claims payment errors in March

October 05, 2021


The California Medical Association (CMA) is urging Congress to address two of our nation’s highest health care priorities in President Biden’s Build Back Better social programs infrastructure legislation – permanent access to more affordable health insurance through the Affordable Care Act (ACA) and lowering the cost of prescription drugs.   

Access to Affordable Health Insurance

The ACA has provided subsidized health care coverage to nearly 9 million people who purchased coverage with federal premium help. However, millions more remain uninsured despite being eligible. Some uninsured did not purchase ACA insurance because their incomes did not qualify them for tax credits or assistance; other uninsured who were eligible either did not know about the available financial assistance or still found coverage unaffordable.

Fortunately, the 2021 American Rescue Plan Act (ARPA) extended eligibility for ACA health insurance tax credits and assistance to those who have incomes over 400% of the federal poverty level. This means most of the uninsured are now eligible for financial assistance. The law also increased the amount of financial assistance for people with lower incomes. Due to the passage of ARPA, ACA coverage has increased 20% and the average savings per family will be at least $70 per month. In fact, 4 of 10 uninsured are eligible for a free or nearly free health plan.

Unfortunately, however, these provisions were only authorized for two years. CMA is urging Congress to ensure the long-term stability, affordability and effectiveness of the ACA by making the provisions of the ARPA permanent.

Reducing the Cost of Prescription Drugs

Patient spending on prescription drugs has doubled since the 1990s.  According to a new Kaiser Family Foundation poll, 80% of Americans believe prescription drugs are too expensive and half of all adults report they do not fill their prescriptions reliably due to the cost. Physicians are concerned about the impact on patient health. 

The Medicare drug pricing provision in the Build Back Better plan  would save patients thousands of dollars on prescription drugs each year, not only  Medicare patients, but also those with private insurance. The bill allows Medicare to negotiate drug prices on many of the highest-priced drugs directly with pharmaceutical companies – including all insulin drugs. These lower prices also would be available to private insurers – allowing tens of millions of people to benefit. In 2024, Medicare would be required to negotiate a minimum of 25 drugs with the greatest savings potential and at least 50 drugs in the following years. And drug-makers would be required to pay rebates on the amount they increase prices over inflation. The nonpartisan Congressional Budget Office estimates that Medicare drug price negotiation would reduce net drug prices by an average 55% for Medicare and privately insured patients.  CMA is strongly urging passage of this meaningful drug pricing reform.   

Pathways to Practice Act

The  legislation would also authorize the Pathways to Practice program—an innovative, historic program that will allow more rural, marginalized and minority students to go to medical school and choose a career in medicine as physicians who will ultimately care for patients in underserved areas. Importantly, it not only provides tuition assistance but stipends as well. It also expands the number of graduate medical education (GME) positions at ACGME accredited institutions to provide more medical residency training opportunities. Students who receive such assistance will be required to serve in underserved areas.

CMA strongly supports this program. Creating a pathway for more marginalized and minority students to practice medicine will improve access to care for traditionally underserved patient populations, advance race-based clinical decision models and ensure that health care disparities are being addressed. This is a significant step forward in helping our nation address racial injustice and advance health equity. It will lead to real improvements in building a more equitable health care system for providers and patients.

 

Was this article helpful?    

COVID-19 Resources

Resources for physicians and health care providers on the latest news, research and developments.

Stay Informed

Opt in to receive updates on the latest health care news, legislation, and more.

Latest News

Load More