How States Can Better Address Insurance Coverage Gaps During COVID-19

| Brittany McCullough
cut-out of family with stethoscope surrounding them

We recently marked the 10th anniversary of the passage of the Patient Protection and Affordable Care Act, affectionately known as the ACA. And while its constitutionality is still being fought in the courts, it still remains the law of the land.

Health-related news as of late has been dominated by COVID-19, but I myself would be remiss if I didn’t take the opportunity to reflect on the most monumental health reform effort of the 21st century thus far – the ACA.

I personally think the ACA provides a nice foundation for policies that states should consider in order to increase coverage during this pandemic. In fact, Families USA recently published a great analysis detailing different approaches states can take to ensure comprehensive coverage during the ongoing pandemic and a few of them were made possible by the ACA.

Here are some examples mentioned in the analysis:

  • Allowing for special enrollment periods and helping consumers file for coverage
  • Expanding Medicaid and allowing for additional flexibility in eligibility requirements
  • Waiving cost sharing requirements (e.g., copayments) related to COVID-19 testing and treatment
  • Modifying prescription drug policies to allow for early refills and increasing ability to obtain 90-day supplies
  • Waiving certain prior authorization requirements
  • Expanding the use of telehealth and requiring parity in reimbursement

While my recent blogs have made a point to focus on telehealth given URAC’s strong interest in the subject (hello, Telehealth Accreditation), I’d like to also mention some other policy options that states are considering to help “flatten the curve”. And, who better to help me discuss all things state policy than URAC’s Vice President of Government Relations and Policy, Aaron Turner-Phifer. I recently had the opportunity to virtually sit down with Aaron and get his take on how statehouses and their regulator counterparts are working to improve access to much needed care as we all continue to grapple with COVID-19. Some excerpts from that conversation are below.

So, Aaron, what do you think is the single most important thing a state policymaker can do today to increase access to health care in light of COVID-19?

 “I think providing direct and immediate cash to hospitals and providers without any hoops to jump through.” He added that “states should suspend any laws and rules that could distract from the response to coronavirus [such as] granting an extension to provider licenses. Many states have also removed restrictions that make it easier for providers to practice via telehealth and across state lines.”

Speaking of suspending potentially burdensome laws and regulations, given the continued coverage of the role of pharmacists in this pandemic and URAC’s footprint in pharmacy quality, what key policies states can enact to empower pharmacists?

Aaron replied the “most important thing that regulators can do right now is to get out of the way [because] patients will continue to need access to their drugs during this time of social distancing.” He reiterated that “states should do everything they can to temporarily suspend or create regulations to support providers [such as suspending] required date reporting to the state.”

Now switching to Medicaid, a joint state and federal health program, how do you think states can better leverage Medicaid during this pandemic?

Aaron responded, “states can leverage their Medicaid system to ensure that low-income Medicaid enrollees seek the care they need free from concerns about the financial burden.” He continued by adding that “some states also have a robust telehealth service for their Medicaid enrollees and participating providers may be well served to expand their service to more patients during this time.”

And last but not least, given we are celebrating the tenth anniversary of the ACA, what do you personally consider to be its biggest accomplishment?

Enthusiastically, Aaron stated the “most important change for consumers was the elimination of two corrosive practices of health insurance: pre-existing conditions and lifetime caps on coverage. These two changes applied to all non-grandfathered health plans so [they] impacted nearly every American who has health insurance. We know that these two provisions meant more affordable care was delivered to those patients and families who needed it most. At the sake of sounding dramatic, these two provisions changed and saved countless lives.”

I myself couldn’t agree more.

Brittany McCullough photo

Brittany McCullough, Manager, Health Policy and Government Programs.

Brittany McCullough, URAC's Manager of Health Policy and Government Programs, tracks and analyzes legislation and regulations of importance to URAC stakeholders. She also helps manage URAC’s public policy external affairs portfolio and oversees compliance with government deemed programs. Most of her policy and research work has been related to the ACA, Medicaid managed care, Part D, telehealth and mental health parity. She holds a B.S. in Neuroscience and a Master of Health Administration.

Views, thoughts and opinions expressed in my articles belong solely to me, and not necessarily to my employer.

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