Policy Watch

Insurer and employer advocates are seeking policy changes—supported by some members of a congressional panel—to increase the appeal of consumer-directed health plans.

May 31—Amid record-breaking enrollment in high-deductible health plans (HDHPs), a congressional panel plans to examine their growth and consider policies to bolster health savings accounts (HSAs).

The June 6 hearing planned by the House Ways and Means Committee’s Health Subcommittee will specifically focus on trends in the use of so-called consumer directed health plans (CDHPs), which are HDHPs that have been paired with some sort of account—usually an HSA.

The panel’s examination of such plans comes amid rapid growth in usage. Enrollment in HDHPs with HSAs reached 21.8 million as of January 2017, according to a survey of 52 health plans by America’s Health Insurance Plans (AHIP). That was an 8 percent increase from the 2016 count of 20.2 million CDHPs.

Similarly, an Employee Benefit Research Institute survey found that 21.4 million people were enrolled in HSA-eligible health plans in 2017.

The popularity of HSAs has increased amid the wider proliferation of HDHPs. Such tax-favored savings accounts allow individuals to save up to $3,450 annually—and families to save $6,850 annually—to cover the cost of qualified medical expenses, such as their plan deductibles.

The population of individuals covered by HSA-eligible HDHPs has shifted sharply toward large group plans, according to AHIP. The share of individuals with HSA-eligible HDHPs who obtained coverage through large group plans increased from 19 percent in 2005 to 82 percent in 2017.

Insurers offering such plans also have added consumer tools to help policy holders manage their costs and optimize the value of their plan, with 82 percent offering healthcare cost information, according to AHIP. Additionally, 69 percent provided physician-specific quality data, and 77 percent provided hospital-specific quality data.

Providers have struggled with HSA plan among patients who have received little education on them from insurers and don’t save much in those accounts.

“People understand how to use it but they are not understanding the plan and say ‘Well, wow, I put that much on my healthcare card; why do I still have a balance?’” Julianne Dreon, assistant vice president for revenue cycle at AnMed Health in Anderson, S.C., said in an interview.

Despite the growth, CDHPs constitute less than half of all HDHPs, according to a May survey from the Centers for Disease Control and Prevention (CDC). Specifically, the CDC found that in 2017, 43.7 percent of U.S. residents younger than 65 with private health insurance were enrolled in an HDHP, and 18.2 percent were enrolled in a CDHP.

Legislation Sought

Among the legislative enhancements to HSAs sought by AHIP is the Chronic Disease Management Act of 2018. That measure, sponsored by a member of the panel holding the June 6 hearing, Rep. Diane Black (R-Tenn.), would give HSA-eligible HDHPs the flexibility to cover services and drugs used to treat chronic diseases before enrollees have paid their deductible.

“Recognizing that preventive treatment is critical to improving health outcomes and avoiding costly long-term complications, Congress allowed for preventive care to be covered pre-deductible,” the AHIP survey authors noted. “There is a similar recognition that ensuring consistent access to treatment for those with chronic conditions such as diabetes, heart disease, and substance abuse disorder can help prevent expensive, debilitating complications.”

Dreon said such changes may help address one of the key negative impacts of HDHPs, where her organization’s patients with chronic health conditions enrolled in such plans often put off needed appointments or reduce required prescriptions.

“There are certain patients you know if they don’t get care, they’re going to end up with a bigger bill,” Dreon said. “They need to do that [policy change] because I really worry about those patients.” 

Other rule changes that insurers are seeking for CDHPs include increasing contribution limits, expanding eligibility to a wider array of plans, and allowing pre-deductible coverage at on-site and retail clinics. Such changes would come through the AHIP-backed Bipartisan HSA Improvements Act, which also would expand access to telemedicine services and to medications without a prescription, and allow HSAs to be used to pay for wellness activities.

That bill, also sponsored by a Health Subcommittee member, Rep. Mike Kelly (R-Pa.), has drawn the support of several major employer groups.

“With so many people increasingly choosing HSA plans, it is important that federal rules allow employers to provide the best benefits possible for their employees,” Kelly said in a release.

Monday, June 4

The West Coast Payer and Provider Summit to Address Social Determinants of Health for Complex Populations takes place (through June 5). Learn more.

The 2018 BIO International Convention is held (through June 7). Learn more.

Tuesday, June 5

Webinar by America’s Health Insurance Plans titled “Embrace Telemedicine to Unlock its True Potential.” Learn more.

Webinar by CMS titled “Fiscal Year 2019 Medicare Spending per Beneficiary (MSPB) Measure Overview.” Learn more.

Webinar by SAMHSA titled “The Opioid Crisis: Prevention, Pain Management and Pharmacology, Social Impact and Best Practices for Program Development and Effectiveness.” Learn more.

Wednesday, June 6

Webinar by HFMA titled “Three Strategies to Achieving a Consumer-Centric Financial Experience.” Learn more.

Hearing by the House Education and Workforce Committee titled “Examining the Policies and Priorities of the U.S. Department of Health and Human Services.” Learn more.

Hearing by the House Energy and Commerce Committee’s Health Subcommittee titled “Examining the Reauthorization of the Pandemic and All-Hazards Preparedness Act.” Learn more.

Call by CMS titled “ Qualified Medicare Beneficiary Program Billing Requirements Call.” Learn more.

Webinar by CMS titled “Hospital IQR Program Fiscal Year 2020 Chart-Abstracted Validation Overview for Targeted Selected Hospitals.” Learn more.

The National ACO, Bundled Payment, and MACRA Summit takes place (through June 8). Learn more.

Webinar by AHIP titled “Navigating Social Determinants of Health.” Learn more.

Thursday, June 7

Webinar by HFMA titled “Lessons Learned When Physicians Disrupt Health Care from the Inside.” Learn more.

Hearing by the House Veterans Affairs Committee’s Health Subcommittee titled “An Assessment of the Potential Health Effects of Burn Pit Exposure among Veterans.” Learn more.

Webinar by CMS titled “Fiscal Year 2019 Clinical Episode-Based Payment Measures Overview.” Learn more.

Webcast of a National Academies committee meeting titled “How to Transform Cancer Control: A Public Workshop." Learn more.

Friday, June 8

Webinar by HFMA titled “The Impact of Market Structure on Total Cost of Care.” Learn more.

Deadline to submit CAHPS Clinician & Group Survey user data for those who administered the survey in 2017. Learn more.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Thursday, May 31, 2018